Breathing treatment (nebulizer)
Facility: Kansas Heart Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $210
- Cash Discount Price: $235
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $31 - $373 | 14% |
| Wppa - All Plans | $149 | 67% |
| Tricare | $182 | 81% |
| UnitedHealthcare | $202 - $373 | 90% |
| Celtic Mcr Adv | $202 | 90% |
| Medicaid / KanCare | $202 - $373 | 90% |
| Humana | $202 | 90% |
| Multiplan - All Plans | $335 | 150% |
| Aetna | $363 - $373 | 162% |
| Soonerselect Mcaid - All Plans | $373 | 167% |
| Celtic Mcaid - All Other Plans | $373 | 167% |
Consumer Guidance & Cost Commentary
For the CPT code 94640 (Breathing treatment), Kansas Heart Hospital in Wichita, KS, lists a gross charge of $373.00, which serves as the maximum billed amount before insurance adjustments. While the facility's cash median rate is $235.00 and the median negotiated rate across payers is $210.00, the actual amount paid by patients varies significantly based on their specific insurance plan. For instance, Blue Cross Blue Shield plans range from $31.00 to $373.00, whereas Soonerselect Medicaid plans pay the full gross amount of $373.00. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics; therefore, patients with high-deductible plans may find paying the cash median of $235.00 directly more cost-effective than relying on insurance, provided they qualify for the cash rate.
To minimize unexpected costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the higher administrative costs associated with insurance billing. Additionally, because over 80% of hospital bills contain errors, consumers should request a detailed, itemized CPT-coded bill rather than accepting a summary invoice, which may hide unbundled charges or services not rendered. When evaluating the facility's pricing, it is more accurate to compare rates against the Medicare benchmark of $223.72 rather than the inflated chargemaster list price, as Medicare rates represent a scientifically validated baseline for the true cost of care delivery.