Breathing treatment (nebulizer)
Facility: Kearny County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $262
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Community Care Health Plan Of | $75 - $1,832 | 34% |
| UnitedHealthcare | $75 - $860 | 34% |
| Blue Cross Blue Shield | $75 - $860 | 34% |
| Aetna | $262 | 117% |
| Humana | $262 | 117% |
| Kansas Solutions | $262 | 117% |
| Wps Gha - Mac J5 Part A | $1,832 | 819% |
Consumer Guidance & Cost Commentary
For the CPT code 94640 (Breathing treatment via nebulizer) at Kearny County Hospital in Lakin, KS, the facility's negotiated rates range from $75 to $1,832 depending on the insurance carrier, with a median negotiated payment of $262. This median rate is significantly higher than the facility's cash median, which is not reported in this dataset. It is important to note that while commercial insurance contracts often cap charges, the actual amount a patient pays can vary based on their deductible status and plan specifics. In cases where a patient's insurance negotiated rate exceeds the cash price, paying out-of-pocket directly may result in lower costs, provided the patient has a high deductible plan. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling services to ensure they are receiving the lowest possible rate.
The facility's pricing structure is benchmarked against Medicare, which serves as a reliable baseline for evaluating commercial markups. For this procedure, the Medicare amount is $223.72, and the facility's median negotiated rate of $262 represents a markup of 1.2 times the Medicare rate. This aligns with fair pricing standards, as commercial rates typically range between 120% and 150% of Medicare, whereas some in-network contracts can reach 200% to 300%. Because over 80% of hospital bills contain errors, patients should request an itemized billing audit to verify that all charges are accurate and that no unbundled codes or services not rendered have been included. If a balance bill arises from an out-of-network provider, patients should dispute the