Breathing treatment (nebulizer)
Facility: Mcpherson Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $174
- Cash Discount Price: $132
- vs. Medicare Baseline: 0.78x 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 |
|---|---|---|
| Wppa - All Plans | $69 - $166 | 31% |
| Medical Associates - All Plans | $74 - $178 | 33% |
| Central Plains - All Plans | $74 - $178 | 33% |
| UnitedHealthcare | $76 - $237 | 34% |
| Christian Health Aid - All Plans | $78 - $190 | 35% |
| Aetna | $81 - $237 | 36% |
| Multiplan - All Plans | $88 - $213 | 39% |
| First Health - All Plans | $93 - $225 | 42% |
| Cigna | $93 - $225 | 42% |
| Health Partners - All Plans | $93 - $225 | 42% |
| Medicaid / KanCare | $98 - $237 | 44% |
| Health Blue Mcaid - All Other Plans | $100 - $242 | 45% |
| Tricare | $177 | 79% |
| Humana | $201 | 90% |
| Blue Cross Blue Shield | $201 | 90% |
| Va Ccn - All Plans | $201 | 90% |
| Healthy Blue Mcr Adv | $201 | 90% |
| Wellcare Mcr Adv - All Plans | $201 | 90% |
| Ambetter / Centene | $232 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, McPherson Hospital in Kansas lists a gross charge of $179.00. While the facility's cash median rate is $132.00, commercial insurance negotiated rates vary significantly across payers, ranging from a low of $69.00 to a high of $242.00. It is important to note that for patients with high-deductible plans, paying the cash price of $132.00 upfront may be more cost-effective than relying on insurance, as many commercial negotiated rates exceed the cash amount. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative processing fees.
When evaluating the cost against federal benchmarks, the Medicare rate for this service is $223.72. Commercial negotiated rates generally average between 200% and 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150% of this benchmark. For this specific procedure, the median negotiated rate of $174.00 falls below the Medicare amount, indicating a rate structure that is lower than the federal baseline for this service. Patients are advised to request an itemized billing audit to ensure no errors exist, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes. Finally, under the No Surprises Act, patients are protected from balance billing for emergency care or non-emergency services at in-network facilities, ensuring they are not billed for the