Breathing treatment (nebulizer)
Facility: Wesley Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $179
- Cash Discount Price: $623
- vs. Medicare Baseline: 0.80x 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 |
|---|---|---|
| United | $43 - $463 | 19% |
| Wppa | $50 - $179 | 22% |
| Aetna | $50 - $367 | 22% |
| Health Partners Of Kansas | $50 - $514 | 22% |
| Ambetter / Centene | $52 - $185 | 23% |
| Preferred Health Choices | $54 - $194 | 24% |
| Medical Associates Health Plan | $54 - $194 | 24% |
| UnitedHealthcare | $69 | 31% |
| Medicaid / KanCare | $71 | 32% |
| Amerigroup | $72 | 32% |
| Spirit Aerosystems | $92 - $301 | 41% |
| First Health | $132 - $474 | 59% |
| Triwest Healthcare Alliance | $187 - $669 | 84% |
| Multiplan | $201 - $926 | 90% |
| Usa Managed Care | $244 - $875 | 109% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment via nebulizer, the cash price at Wesley Medical Center in Wichita, KS, is $623.00. This cash rate is significantly higher than the state average, which sits at $223.72 (Medicare benchmark), indicating a substantial markup on the base cost of care. While commercial insurance plans like United and Wppa negotiate rates ranging from $43 to $463, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. It is important to note that while the facility offers a cash price, commercial payers may still apply administrative fees or deductibles that result in higher out-of-pocket costs than the listed cash amount.
Patients should be aware that commercial negotiated rates can sometimes be inflated by administrative overhead, with some plans paying up to $926 for this service, far exceeding the cash price. To minimize costs, individuals should verify if their specific plan has a deductible that has already been met, as paying the full negotiated rate without meeting this threshold can be financially burdensome. Additionally, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. If a patient receives a bill from an out-of-network provider or encounters unexpected charges, they should request an itemized audit to identify errors or unbundled codes before agreeing to any payment plan.