Breathing treatment (nebulizer)
Facility: Grisell Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $52
- Cash Discount Price: $66
- vs. Medicare Baseline: 0.23x 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 | $37 - $69 | 17% |
| Blue Cross Blue Shield | $39 | 17% |
| Medicaid / KanCare | $49 - $69 | 22% |
| Humana | $69 - $316 | 31% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Grisell Memorial Hospital in Ransom, Kansas, lists a gross charge of $69.00. This amount is significantly higher than the Medicare benchmark of $223.72, which serves as the federal baseline for evaluating hospital pricing markups. While the facility's cash median price is $66.00, patients should note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, Humana's negotiated rate ranges up to $316.00 across three plans, whereas the facility's cash price remains lower. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the $66.00 median cash rate is lower than the negotiated amounts charged by major payers like UnitedHealthcare ($37.00–$69.00) and Medicaid/KanCare ($49.00–$69.00).
To minimize out-of-pocket costs, consumers should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront payment incentives can bypass the higher administrative costs associated with insurance billing. It is important to verify your specific plan's allowed amount, as assuming that being in-network guarantees the lowest price can lead to confusion, as different insurers negotiate varying rates for the same service. Additionally, if you choose to use insurance, be aware that balance billing could occur if you are out-of-network, though the No Surprises Act provides protections for emergency care and non-emergency services at in-network facilities. Always request a detailed, itemized