Breathing treatment (nebulizer)
Facility: Ellinwood District Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $39
- Cash Discount Price: $47
- vs. Medicare Baseline: 0.17x 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 |
|---|---|---|
| Aetna | $35 - $140 | 16% |
| UnitedHealthcare | $35 - $140 | 16% |
| Blue Cross Blue Shield | $35 - $140 | 16% |
| Cigna | $35 - $140 | 16% |
| Humana | $35 - $140 | 16% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Ellinwood District Hospital in Kansas lists a gross charge of $55.00. While the facility's cash median rate is $47.00, commercial insurance payers such as Aetna, UnitedHealthcare, and Blue Cross Blue Shield negotiate a higher average of $83.00. This discrepancy highlights that for patients with high-deductible plans, paying the cash price directly can sometimes be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price due to administrative overhead and contract structures. It is important to verify your specific plan's allowed amount before scheduling, as in-network status does not guarantee the lowest possible price.
To minimize potential costs, patients should proactively inquire about self-pay or prompt-pay discounts, which can range from 20% to 50% off the billed amount when paid upfront. Additionally, comparing this facility's pricing to regional benchmarks reveals significant variation; the Medicare benchmark for this service is $223.72, which serves as a standardized baseline for fair pricing. Although the provided data does not include explicit state or county average comparisons for this specific code, understanding that commercial rates often average 200% to 300% of Medicare rates can help contextualize the $83.00 negotiated figure. Consumers are advised to request an itemized bill to ensure no errors exist and to avoid balance billing, which is restricted for emergency care under federal protections.