Breathing treatment (nebulizer)
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $190
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.85x 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 |
|---|---|---|
| Va | $188 | 84% |
| Saint Lukes Health Systems | $188 | 84% |
| Humana | $188 | 84% |
| Medicare (plans) | $188 - $192 | 84% |
| Vc Hope | $188 | 84% |
| Via Christi Research | $188 | 84% |
| Blue Cross Blue Shield | $192 | 86% |
| UnitedHealthcare | $192 - $527 | 86% |
| Corizon | $235 | 105% |
| Smarthealth | $263 | 118% |
| Medicaid / KanCare | $320 | 143% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the negotiated rates across 11 payers range from $188 to $527, with a median negotiated amount of $190.00. The Medicare benchmark for this service is $223.72, which serves as a critical baseline for evaluating pricing fairness. While commercial rates vary significantly by insurer, the lowest negotiated amounts start at $188, and the highest observed rate is $527 for UnitedHealthcare. It is important to note that cash-pay options are not listed in the current data; however, patients with high-deductible plans should be aware that paying out-of-pocket can sometimes be more cost-effective if the insurance negotiated rate exceeds the facility's cash price. Since cash rates are unavailable here, the focus remains on the negotiated landscape, where rates generally align closely with the Medicare benchmark, suggesting minimal markup compared to typical commercial pricing structures where rates often reach 200% to 300% of Medicare.
To ensure you are not overcharged, it is advisable to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If you receive a summary bill, demand a full line-by-line statement showing specific CPT codes and unit costs to identify any charges for services not rendered or supplies that were cancelled. Additionally, always inquire about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront payment incentives can reduce costs by 20% to 50% by bypassing administrative claim processing fees. Given that