Breathing treatment (nebulizer)
Facility: Rawlins County Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $331
- Cash Discount Price: $378
- vs. Medicare Baseline: 1.48x 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 | $42 | 19% |
| UnitedHealthcare | $331 - $444 | 148% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the Rawlins County Health Center in Atwood, KS, lists a cash median price of $378.00. This cash rate is notably lower than the facility's negotiated rates, which range from $331.00 to $444.00 depending on the insurance carrier. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $378.00 upfront could result in immediate savings compared to the higher amounts your insurance might negotiate or allow.
To ensure you are not overcharged, it is crucial to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are receiving care from an out-of-network provider, you may be subject to balance billing for the difference between the provider's chargemaster rate and your insurance's allowed amount; however, the No Surprises Act generally protects you from these surprise bills for emergency care and non-emergency services at in-network facilities. Before scheduling, we strongly recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce your bill by 20% to 50% if paid in full within a short window, effectively bypassing costly insurance claims processing.