Breathing treatment (nebulizer)
Facility: Lane County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $45
- Cash Discount Price: $45
- vs. Medicare Baseline: 0.20x 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.
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 | $18 - $56 | 8% |
| Aetna | $18 - $53 | 8% |
| Healthy Blue Mcr Adv - All Other Plans | $20 - $235 | 9% |
| Healthy Blue Mcaid | $20 - $56 | 9% |
| Medicaid / KanCare | $20 - $235 | 9% |
| Wppa Providers-All Plans | $30 - $84 | 13% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Lane County Hospital in Dighton, Kansas, lists a cash price of $45.00. This cash rate is identical to the facility's median negotiated rate and the median amount paid by insurers, suggesting that for this specific service, there is no significant gap between self-pay and insurance reimbursement. The facility's cash price is notably lower than the state average for this procedure, which typically ranges from $30 to $84 depending on the payer, and falls well below the highest negotiated rates seen in the region, such as the $235 allowed by Healthy Blue Mcr Adv. Because the cash price matches the negotiated rate, patients with high-deductible plans may find paying out-of-pocket immediately to be the most cost-effective option, avoiding potential deductibles or copays that could exceed the $45.00 total.
While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should still verify their specific plan details before scheduling. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to confirm that the nebulizer service is covered under your plan and that no unexpected ancillary charges will arise. If you are self-paying, you should explicitly ask the billing department about "prompt-pay" discounts, which can further reduce the $45.00 cost if paid in full upfront. Additionally, if you receive an itemized bill, request a full line-by-line audit to ensure no unbundled codes or services not rendered are included, as over 80% of hospital