Breathing treatment (nebulizer)
Facility: Centura St. Catherine-Dodge City
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $299
- Cash Discount Price: $157
- vs. Medicare Baseline: 1.34x 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 |
|---|---|---|
| Medicare (plans) | $7 | 3% |
| Aetna | $7 - $328 | 3% |
| Cigna | $7 | 3% |
| Kansas Health | $7 | 3% |
| Kaiser | $7 | 3% |
| Humana | $7 | 3% |
| Blue Cross Blue Shield | $7 - $299 | 3% |
| Centura Employee Plan | $131 - $143 | 59% |
| UnitedHealthcare | $246 - $270 | 110% |
| Wpaa | $262 - $287 | 117% |
| Multiplan | $299 - $369 | 134% |
| Christian Health Aid | $299 - $328 | 134% |
| Health Partners Of Kansas | $336 - $369 | 150% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median price is $157.00, which is significantly lower than the state average of $285.00. While many commercial payers negotiate rates ranging from $246 to $369, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $157.00. It is important to note that the facility's cash rate is also lower than the Medicare benchmark of $223.72, suggesting that paying out-of-pocket could result in substantial savings compared to standard insurance reimbursement for this specific service.
The facility, located in Dodge City, KS, offers a variety of negotiated rates across 13 payers, with the lowest commercial rates starting at $7 and the highest reaching $369. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, unexpected ancillary services or out-of-network providers could still trigger additional charges. To ensure the most accurate pricing, consumers are encouraged to request a full itemized bill before payment and to inquire directly about prompt-pay discounts, which can reduce the final amount owed by 20% to 50% if settled upfront. Always verify your specific plan's deductible status and allowed amounts with the hospital prior to scheduling to avoid unexpected financial burdens.