Breathing treatment (nebulizer)
Facility: Pratt Regional Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $204
- Cash Discount Price: $163
- vs. Medicare Baseline: 0.91x 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.
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 |
|---|---|---|
| Christian Health Aid | $80 - $269 | 36% |
| UnitedHealthcare | $89 - $365 | 40% |
| Health Partners Of Kansas | $91 - $304 | 41% |
| Aetna | $96 - $322 | 43% |
| Choicecare | $107 - $358 | 48% |
| Celtic Insurance Company | $198 | 89% |
| Healthy Blue | $204 | 91% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Pratt Regional Medical Center in Pratt, KS, the facility's cash median price is $163.00. This cash rate is notably lower than the negotiated rates paid by major insurers, which range from $80 to $365 depending on the payer. For instance, UnitedHealthcare's negotiated rate spans $89 to $365, while Celtic Insurance Company and Healthy Blue have fixed negotiated rates of $198. Because commercial insurance contracts often include administrative overheads that inflate the baseline price, patients with high-deductible plans may find paying the cash median of $163.00 directly more cost-effective than relying on insurance, especially if their out-of-pocket costs exceed this amount.
The facility's pricing structure aligns closely with state and county benchmarks, with the cash rate of $163.00 sitting below the state average for this service. While the Medicare benchmark for this procedure is $223.72, the facility's cash price remains competitive, reflecting a ratio of 0.9 relative to Medicare. Patients should be aware that while the facility offers a cash median, they should explicitly request "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate. It is also important to note that the facility is an acute care hospital with a proprietary ownership model, and any balance billing scenarios would be governed by federal protections such as the No Surprises Act, which prevents unexpected charges for out-of-network services at in-network facilities.