Breathing treatment (nebulizer)
Facility: Susan B Allen Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $554
- Cash Discount Price: $214
- vs. Medicare Baseline: 2.48x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $223.72 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 248% of the Medicare baseline (a markup of 148%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 156% |
| Providrs Care | $757 | 338% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $214.00, which is notably lower than the facility's negotiated rates of $554.00. While the facility's gross charge is $329.00, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount, though the data indicates no specific negotiated rate was available for comparison against the state or county average. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to the true cost of care.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected ancillary charges can still occur if specific services are billed separately. To avoid potential errors, consumers are encouraged to request a full itemized bill before paying, as summary invoices can obscure unbundled codes or services not rendered. Additionally, since hospitals often offer prompt-pay discounts of 20% to 50% for upfront payment, patients should explicitly ask for self-pay or prompt-pay rates prior to scheduling to ensure they are not inadvertently enrolled in a billing cycle that voids these savings.