Breathing treatment (nebulizer)
Facility: Menorah Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $79
- Cash Discount Price: $241
- vs. Medicare Baseline: 0.35x 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 | $31 - $108 | 14% |
| Ambetter / Centene | $45 | 20% |
| Oscar | $46 | 21% |
| Nhc Advantage | $46 | 21% |
| Wppa Providrs Care Network | $48 | 21% |
| Humana | $51 - $64 | 23% |
| United | $60 - $173 | 27% |
| Cigna | $60 - $192 | 27% |
| Aetna | $63 - $123 | 28% |
| Amerigroup | $69 | 31% |
| Healthyblue | $70 | 31% |
| Medicaid / KanCare | $71 | 32% |
| Unicare | $72 | 32% |
| Universal Healthcare | $84 | 38% |
| Coventry | $97 | 43% |
| Coventry Kc Mo | $99 | 44% |
| College Park Family Care Center | $103 | 46% |
| Oha Network | $120 | 54% |
| Multiplan | $128 - $192 | 57% |
| Corvel Corporation | $156 | 70% |
| Triwest Health Alliance | $180 | 80% |
| Focus Healthcare Mgmt, Inc | $180 | 80% |
| Cco, Inc. | $180 | 80% |
| Home State Health Plan | $182 | 81% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Menorah Medical Center in Overland Park, KS, lists a cash price of $241.00. This cash rate is identical to the facility's median paid amount and matches the Medicare benchmark of $223.72, indicating no markup above the federal baseline for this service. While the facility's negotiated rates with insurance payers range from $31 to $192, these amounts are often higher than the cash price due to administrative costs and contract structures. For patients with high-deductible plans, paying the cash price of $241.00 upfront may be more cost-effective than relying on insurance, which could result in higher allowed amounts or out-of-pocket costs if deductibles have not yet been met.
To minimize unexpected costs, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these programs can reduce the bill by 20% to 50% by bypassing insurance billing cycles. It is also important to request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a balance bill arises from an out-of-network provider, patients should dispute the charge immediately and request a No Surprises Act audit to avoid paying the difference between the provider's chargemaster and the insurance allowed amount.