Breathing treatment (nebulizer)
Facility: Stormont Vail Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $183
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.82x 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 |
|---|---|---|
| Ambetter / Centene | $70 | 31% |
| UnitedHealthcare | $70 | 31% |
| Blue Cross Blue Shield | $71 - $254 | 32% |
| Humana | $183 - $187 | 82% |
| Aetna | $183 - $187 | 82% |
Consumer Guidance & Cost Commentary
For this procedure at Stormont Vail Hospital in Topeka, KS, the most meaningful benchmark is the Medicare amount of $223.72, which serves as the federal baseline for cost evaluation. The facility's cash price is listed as $194, making it lower than the Medicare benchmark, while the gross charge of $194 remains the starting point before any insurance negotiations apply. It is important to note that while the cash rate is lower than the Medicare benchmark, patients with high-deductible plans may find the cash price advantageous if their insurer's negotiated rate exceeds this amount; however, in this specific case, the cash rate is already favorable compared to the Medicare standard.
Commercial insurance rates vary significantly among payers, with the median negotiated rate set at $183 and the median paid amount reaching $8,624. The data indicates five distinct payers, including Ambetter / Centene, UnitedHealthcare, Blue Cross Blue Shield, Humana, and Aetna, with negotiated rates ranging from a low of $70 to a high of $254 depending on the specific plan. Because the cash price of $194 is lower than the median negotiated rate of $183 for some payers and the gross charge of $194, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling. If balance billing occurs due to out-of-network ancillary services, patients should request an itemized billing audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.