Breathing treatment (nebulizer)
Facility: Overland Park Reg Med Ctr
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $166
- Cash Discount Price: $512
- vs. Medicare Baseline: 0.74x 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 | $67 - $220 | 30% |
| United | $69 - $231 | 31% |
| Amerigroup | $69 | 31% |
| Healthyblue | $70 | 31% |
| Medicaid / KanCare | $71 | 32% |
| Unicare | $72 | 32% |
| Aetna | $72 - $261 | 32% |
| Ambetter / Centene | $95 | 42% |
| Oscar | $97 | 43% |
| Nhc Advantage | $97 | 43% |
| Wppa Providrs Care Network | $102 | 46% |
| Humana | $108 - $136 | 48% |
| Cigna | $127 - $189 | 57% |
| Universal Healthcare | $179 | 80% |
| Home State Health Plan | $182 | 81% |
| Coventry | $206 | 92% |
| Coventry Kc Mo | $210 | 94% |
| College Park Family Care Center | $220 | 98% |
| Oha Network | $256 | 114% |
| Multiplan | $272 - $410 | 122% |
| Corvel Corporation | $333 | 149% |
| Triwest Health Alliance | $384 | 172% |
| Focus Healthcare Mgmt, Inc | $384 | 172% |
| Cco, Inc. | $384 | 172% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the Overland Park Reg Med Ctr lists a cash price of $512.00, which matches the facility's cash median. This cash rate is significantly higher than the Medicare benchmark of $223.72, indicating a markup of 0.7 times the Medicare amount. While the facility offers a cash price, commercial insurance plans negotiate rates that often exceed this amount; for instance, Blue Cross Blue Shield plans pay between $67 and $220, and Aetna plans range from $72 to $261. Patients with high-deductible plans may find the $512.00 cash price more affordable than their insurance's negotiated rate, provided they have not yet met their deductible or if the insurer's allowed amount is lower than the cash charge.
To minimize costs, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing administrative claim processing fees. It is also important to avoid balance billing by ensuring the facility is in-network and understanding that the No Surprises Act protects against unexpected out-of-network charges for emergency care at in-network facilities. Finally, patients should never accept a summary bill as final; instead, they should demand a full itemized statement to verify that no unbundled codes or services not rendered have been charged, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.