Breathing treatment (nebulizer)
Facility: Ashland Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $300
- Cash Discount Price: $261
- vs. Medicare Baseline: 1.34x 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 |
|---|---|---|
| Blue Cross Blue Shield | $25 - $118 | 11% |
| Compalliance-All Plans | $60 - $282 | 27% |
| Health Partners Of Kansas-All Plans | $64 - $300 | 29% |
| Multiplan-All Plans | $74 - $346 | 33% |
| Medica Mcare - All Plans | $75 - $353 | 34% |
| Healthy Blue Mcr Adv - All Other Plans | $75 - $353 | 34% |
| UnitedHealthcare | $75 - $353 | 34% |
| Aetna | $75 - $353 | 34% |
| Health Choice-All Plans | $75 - $353 | 34% |
| Medicaid / KanCare | $75 - $353 | 34% |
| Medicare (plans) | $75 - $353 | 34% |
| Providers Care (Wppa)-All Plans | $112 - $530 | 50% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Ashland Health Center in Ashland, Kansas, the facility's cash median price is $261.00, while the median negotiated rate across 12 payers is $300.00. This suggests that for patients with high-deductible plans or those without insurance, paying cash directly may result in lower out-of-pocket costs compared to using an in-network plan, as the insurance negotiated rate exceeds the cash price. It is important to note that while the facility is a Critical Access Hospital in a Voluntary non-profit structure, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the total cost by bypassing the administrative overhead associated with insurance claims processing.
When evaluating the financial impact of this service, it is crucial to compare rates against the Medicare benchmark rather than the facility's gross charges, as the latter often inflates the perceived value of discounts. The Medicare amount for this procedure is $223.72, which serves as the objective baseline for determining fair pricing; commercial negotiated rates typically range from 200% to 300% of this figure, though fair pricing is generally defined between 120% and 150%. Additionally, consumers should be aware of the risks of balance billing if they receive care from out-of-network providers, which can lead to unexpected bills for the difference between the provider's chargemaster rate and the insurance allowed amount. To avoid these pitfalls, patients should request a full itemized bill to verify that no unbundled codes or services not rendered have