Breathing treatment (nebulizer)
Facility: Saint Luke'S South Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $210
- Cash Discount Price: $215
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| UnitedHealthcare | $47 - $123 | 21% |
| Medicaid / KanCare | $69 - $76 | 31% |
| Humana | $115 - $234 | 51% |
| Cigna | $115 - $272 | 51% |
| Transplants-Case Rates [5750] | $125 - $358 | 56% |
| Blue Cross Blue Shield | $161 - $269 | 72% |
| Aetna | $196 - $340 | 88% |
| First Health [5512] | $212 | 95% |
| Commercial-Contracted [8000] | $268 - $946 | 120% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Saint Luke's South Hospital in Overland Park, KS, lists a cash median price of $215.00, which is notably lower than the facility's gross charge of $358.00. While the hospital's negotiated rates with major payers like UnitedHealthcare and Medicaid/KanCare range from $47 to $123, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. The facility's cash rate is also lower than the Medicare benchmark of $223.72, suggesting a potentially fairer price point compared to the federal baseline. However, patients should verify if their specific insurance plan has a negotiated rate that falls below the cash price, as some commercial contracts may offer lower allowed amounts than the self-pay option.
To ensure you are receiving the best possible rate, it is crucial to request an itemized billing audit before finalizing payment, as summary bills can obscure individual charges or unbundled services that should be consolidated. If you choose to use insurance, be aware that administrative processing fees and contract dynamics often inflate the baseline price, but the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% if you settle the bill upfront, effectively bypassing the costly claims cycle. Always confirm your deductible status and request a written waiver of insurance submission if you intend to pay cash directly to secure the lowest possible rate.