Breathing treatment (nebulizer)
Facility: Kansas Medical Center Llc
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $57
- Cash Discount Price: $44
- vs. Medicare Baseline: 0.25x 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 |
|---|---|---|
| Wppa | $23 - $36 | 10% |
| Aetna | $26 - $40 | 12% |
| United | $28 - $44 | 13% |
| Blue Cross Blue Shield | $57 - $202 | 25% |
| Tricare | $57 - $89 | 25% |
| Medicaid / KanCare | $57 - $69 | 25% |
| Ambetter / Centene | $57 - $89 | 25% |
| Medadv_Wellcare | $57 - $89 | 25% |
| Humana | $57 - $89 | 25% |
| Indian Health | $182 | 81% |
| Three_Rivers | $404 | 181% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Kansas Medical Center Llc in Andover, KS, lists a cash median price of $44.00, which is lower than the facility's negotiated rates of $57.00. While the facility's gross charge is $73.00, commercial payers such as Blue Cross Blue Shield, Tricare, and Medicaid/KanCare have negotiated rates ranging from $57.00 to $202.00, with the highest single-payer rate of $404.00 coming from Three Rivers. This pricing structure highlights that paying cash upfront can be more cost-effective than relying on insurance, as the cash price avoids the administrative overhead and markup inherent in the insurance billing cycle. Patients with high-deductible plans may find it beneficial to pay the $44.00 cash median directly, provided they confirm that their specific insurance plan's negotiated rate exceeds this amount, potentially resulting in higher out-of-pocket costs if they choose to use their coverage.
To minimize potential financial surprises, consumers should actively request "self-pay" or "prompt-pay" discounts before scheduling any services, as these upfront payment incentives can further reduce the final bill. It is important to note that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though patients should still verify their network status to avoid unexpected charges from out-of-network ancillary services like emergency physicians or labs. Furthermore, while the facility's facility rating is 2, the most critical factor for cost transparency is comparing the final allowed amount to the Medicare benchmark of $22