Breathing treatment (nebulizer)
Facility: Kansas City Orthopaedic Institute
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $492
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.20x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 220% of the Medicare baseline (a markup of 120%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $189 | 84% |
| UnitedHealthcare | $189 | 84% |
| Cigna | $191 | 85% |
| Blue Cross Blue Shield | $492 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the Kansas City Orthopaedic Institute in Leawood, KS, has a negotiated rate of $492.00 with four major payers, including Blue Cross Blue Shield. This negotiated amount is significantly higher than the Medicare benchmark of $223.72, which serves as the federal baseline for the true cost of care. While commercial insurance contracts often result in rates exceeding 200% of Medicare due to administrative overhead and contract dynamics, patients with high-deductible plans may find paying the cash price more advantageous, as the cash rate is not listed in the data but is typically lower than the insurer's allowed amount. It is important to note that while the facility is an Acute Care Hospital owned by a physician group, the specific cash price for this service is not disclosed in the current report.
Patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, meaning the facility cannot bill you for the difference between their chargemaster and the insurance payment. However, if you receive care from an out-of-network provider at this facility, or if ancillary services like emergency physicians are out-of-network, you may face unexpected bills. To protect yourself, always request a full itemized bill before paying, as summary invoices can hide unbundled codes or services not rendered. Additionally, since the facility offers prompt-pay discounts to patients who pay upfront, you should contact the billing department directly to confirm if a self-pay or prompt-pay rate is available, which could reduce your out-of-pocket costs compared to the standard negotiated rate.