Breathing treatment (nebulizer)
Facility: Lmh
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $221
- Cash Discount Price: $66
- vs. Medicare Baseline: 0.99x 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 |
|---|---|---|
| Blue Cross Blue Shield | $70 - $262 | 31% |
| UnitedHealthcare | $70 - $262 | 31% |
| Cigna | $150 - $221 | 67% |
| Aetna | $167 - $218 | 75% |
| Non Contracted | $210 | 94% |
| Haskell Indian Health Services | $221 | 99% |
| Humana | $221 | 99% |
| Medicare (plans) | $221 | 99% |
| Allwell | $225 | 101% |
| First Health | $244 | 109% |
| Ambetter / Centene | $262 | 117% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment (nebulizer), the facility's gross charge is $262.00, which aligns with the highest negotiated rates observed among Blue Cross Blue Shield and UnitedHealthcare plans. While the facility's cash median price of $66.00 is significantly lower than the typical commercial negotiated rates, patients with high-deductible plans may find that paying cash upfront is more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash price. It is important to note that the facility is a government-owned local hospital in Lawrence, KS, and while the facility holds a 4-star rating, the specific negotiated rates vary widely across different payers, ranging from $70 to $262 depending on the insurance plan and contract status.
When evaluating the cost relative to federal standards, the Medicare amount of $223.72 serves as a key benchmark, showing that the gross charge is only slightly above the Medicare rate. The median negotiated rate across all payers is $221.00, which is close to the Medicare benchmark, suggesting that the facility's commercial contracts are relatively fair compared to the national average. Patients should be aware that balance billing is generally prohibited for emergency services at in-network facilities under the No Surprises Act, but it is crucial to request an itemized bill before payment to ensure no unbundled charges or services not rendered are included. Additionally, since the facility offers prompt-pay discounts for upfront payment, patients should explicitly ask for self-pay rates prior to scheduling to avoid being billed the full gross charge or a higher insurance negotiated amount.