Breathing treatment (nebulizer)
Facility: Nmc Health
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $131
- Cash Discount Price: $141
- vs. Medicare Baseline: 0.59x 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 |
|---|---|---|
| Bluestem Pace | $8 - $196 | 4% |
| Medicaid / KanCare | $12 - $314 | 5% |
| Leading Age | $12 - $314 | 5% |
| Wppa | $21 - $114 | 9% |
| Occunet | $23 - $125 | 10% |
| Samaritan Ministries International | $25 - $135 | 11% |
| Medincrease Health Plan | $25 - $135 | 11% |
| Prime Health Services | $29 - $156 | 13% |
| Aetna | $32 - $171 | 14% |
| UnitedHealthcare | $35 - $187 | 16% |
| Cigna | $37 - $198 | 17% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the gross charge at Nmc Health in Newton, KS is $208.00. While the facility offers a cash median price of $141.00, which is lower than the Medicare benchmark of $223.72, commercial insurance plans negotiate significantly higher rates. The data shows that in-network payers like Blue Cross Blue Shield have a fixed negotiated rate of $254.00, while other plans such as Medicaid/KanCare and Leading Age range from $12.00 to $314.00. This disparity highlights that for patients with high-deductible plans, paying the cash price of $141.00 upfront may result in lower out-of-pocket costs compared to the negotiated rates their insurance would allow, which often exceed the cash price due to administrative overhead and contract structures.
Patients should be aware that commercial insurance contracts often create a ceiling on what insurers will pay, meaning the allowed amount can sometimes be higher than the cash-pay rate. To ensure you receive the best possible price, it is recommended to explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these can further reduce the cost below the cash median. Additionally, if you receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to request an itemized audit to verify all codes and services, and you may be protected from balance billing for emergency or non-emergency services at in-network facilities under federal regulations. Always confirm your specific plan's deductible status and allowed amounts directly with the hospital prior to