Breathing treatment (nebulizer)
Facility: Labette Health
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $172
- Cash Discount Price: $84
- vs. Medicare Baseline: 0.77x 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 |
|---|---|---|
| Kansas Superior Select | $7 - $194 | 3% |
| Montgomery County | $7 - $344 | 3% |
| Aetna | $7 | 3% |
| Uhccp | $10 | 4% |
| Medicaid / KanCare | $89 - $188 | 40% |
| Multiplan | $168 | 75% |
| UnitedHealthcare | $172 - $188 | 77% |
| Choicecare (First Health Network) | $178 | 80% |
| Health Partners Of Kansas, Inc | $178 | 80% |
| Humana | $188 | 84% |
| Wellcare | $188 | 84% |
| Blue Cross Blue Shield | $188 - $254 | 84% |
| Ambetter / Centene | $198 | 89% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, Breathing treatment (nebulizer), Labette Health in Parsons, KS, lists a cash median price of $84.00, which is significantly lower than the facility's gross charge of $121.00. While the facility is a government-owned acute care hospital, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For instance, UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $172.00 to $254.00, which are higher than the cash rate. This dynamic suggests that patients with high-deductible plans might save money by paying the cash price directly, provided they qualify for the facility's self-pay or prompt-pay discounts. It is crucial to verify these discounts with the hospital before scheduling, as waiting until after a claim is submitted may void the agreement.
When evaluating costs, it is important to compare rates against objective benchmarks rather than the facility's inflated chargemaster list. The Medicare amount for this service is $223.72, and the facility's negotiated rates generally align with or exceed fair pricing standards relative to this baseline. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to ensure no unbundled codes or services not rendered are included. Since over 80% of hospital bills contain errors, disputing any discrepancies in writing with the billing supervisor is the most effective way to reduce medical debt. Ultimately, understanding the difference between the cash price, the Medicare rate, and the specific negotiated rates for your