Breathing treatment (nebulizer)
Facility: Rooks County Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $134
- Cash Discount Price: $111
- vs. Medicare Baseline: 0.60x 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 |
|---|---|---|
| Veterans Admin - All Plans | $70 | 31% |
| Tricare | $70 | 31% |
| Celtic Mcr Adv | $70 | 31% |
| Celtic Comm - All Other Plans | $77 | 34% |
| Aetna | $134 | 60% |
| Preferred Benefits Admin | $134 | 60% |
| UnitedHealthcare | $134 | 60% |
| Health Partners - All Plans | $141 | 63% |
| Preferred Hlthcare - All Other Plans | $141 | 63% |
| Healthy Blue Mcaid - All Plans | $148 | 66% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Rooks County Health Center in Plainville, KS, the facility's cash median rate is $111.00, while the median negotiated rate across 11 payers is $134.00. This indicates that paying cash upfront may result in a lower out-of-pocket cost compared to using insurance, as the negotiated rates exceed the cash price. Patients with high-deductible plans should consider the cash option if their insurance allowed amount is higher than $111.00, as this could reduce their immediate financial burden. It is important to verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill for those paying in full before or shortly after the service.
The facility's cash rate of $111.00 is notably lower than the Medicare benchmark of $223.72, suggesting a markup of approximately 50% below the federal standard. While the data does not provide specific state or county averages for this procedure, the significant gap between the cash price and the Medicare rate highlights the importance of comparing commercial rates against the government baseline rather than the hospital's full chargemaster list. Consumers should be aware that commercial negotiated rates often include administrative overhead, which can inflate the baseline price by 20% to 40%. If a patient receives care from an out-of-network provider at this facility, they may face balance billing for the difference between the allowed amount and the full charge, though the No Surprises Act protects against such billing for emergency and non-emergency services at in-network facilities.