Breathing treatment (nebulizer)
Facility: Wichita County Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $48
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.21x 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 |
|---|---|---|
| Medicaid / KanCare | $44 | 20% |
| UnitedHealthcare | $53 | 24% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, "Breathing treatment (nebulizer)," Wichita County Health Center in Leoti, KS, lists a cash median price of $42.00, which is lower than the facility's negotiated rates of $48.00 and the Medicaid/KanCare allowed amount of $44.00. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that cash payments can sometimes be more affordable than insurance claims, particularly for those with high-deductible plans where the insurer's negotiated rate exceeds the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront incentives can further reduce the final cost by bypassing administrative processing fees.
The Medicare benchmark for this service is $223.72, which serves as a key reference point for evaluating pricing fairness, as commercial rates often exceed this baseline due to administrative overhead and contract dynamics. Although the data does not provide specific state or county average figures for comparison, the facility's cash rate remains significantly below the Medicare amount, suggesting a competitive pricing structure relative to federal standards. Consumers should avoid accepting summary bills as final invoices and instead request a detailed, itemized statement to ensure no unbundled charges or services not rendered are included. If any balance billing occurs, patients should verify the legality of the bill under the No Surprises Act before making immediate payments, as federal protections may limit liability for out-of-network services at in-network facilities.