Breathing treatment (nebulizer)
Facility: Providence Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $206
- Cash Discount Price: $206
- vs. Medicare Baseline: 0.92x 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 |
|---|---|---|
| Aetna | $13 - $206 | 6% |
| Oha Networks | $31 | 14% |
| Worker Compensation | $32 | 14% |
| Medicaid / KanCare | $69 | 31% |
| UnitedHealthcare | $69 - $220 | 31% |
| Healthy Blue | $70 - $217 | 31% |
| Celtic | $70 - $220 | 31% |
| Medicare (plans) | $206 | 92% |
| Midland Care Connection | $206 | 92% |
| Cigna | $206 | 92% |
| Tricare | $206 | 92% |
| Kansas Superior Select | $217 | 97% |
| Centurion | $220 | 98% |
| Well Path Prison | $220 | 98% |
| Blue Cross Blue Shield | $220 | 98% |
| Corizon | $220 | 98% |
| Employer Direct Healthcare | $220 | 98% |
| Naphcare | $220 | 98% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment using a nebulizer, the gross charge at Providence Medical Center in Kansas City is $220.00. While the facility's cash median rate is $206.00, commercial insurance negotiated rates vary significantly, ranging from a low of $13.00 with Aetna to the full gross amount of $220.00 with several payers including UnitedHealthcare and Celtic. It is important to note that cash-pay rates can sometimes be more affordable for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Additionally, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront fee reductions can lower the final cost by bypassing administrative billing cycles.
The Medicare benchmark for this service is $223.72, which serves as an objective baseline for evaluating pricing markups. Commercial negotiated rates often exceed this benchmark due to administrative overhead and contract dynamics, though the cash rate of $206.00 is slightly below the Medicare amount. If you receive a bill from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider bills you for the difference between their full charge and the insurance allowed amount. To protect yourself, always request a detailed, itemized bill to identify any errors, double-billing, or unbundled codes, and do not sign away your rights to dispute out-of-network charges without understanding the terms.