Breathing treatment (nebulizer)
Facility: F W Huston Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $40
- Cash Discount Price: $90
- vs. Medicare Baseline: 0.18x 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 |
|---|---|---|
| Aetna | $34 - $136 | 15% |
| Humana | $36 - $143 | 16% |
| Blue Cross Blue Shield | $38 - $42 | 17% |
| Cigna | $38 - $154 | 17% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, "Breathing treatment (nebulizer)," F W Huston Medical Center in Winchester, KS, lists a cash median price of $90.00 and a median negotiated rate of $40.00. It is important to note that while commercial insurance contracts often cap payments, the negotiated rate of $40.00 is significantly lower than the facility's cash price of $90.00. In many cases with high-deductible plans, paying the cash price directly can be more cost-effective than relying on insurance, as the insurer's allowed amount may exceed the cash rate. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
When evaluating the facility's pricing, it is crucial to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare amount for this service is $223.72, which serves as the objective baseline for fair pricing. While the facility's cash rate of $90.00 is lower than the Medicare amount, the median negotiated rate of $40.00 represents the actual amount commercial payers like Aetna, Humana, Blue Cross Blue Shield, and Cigna are contractually allowed to pay. Patients should be aware that commercial rates can sometimes be lower than Medicare, but they must verify their specific plan's deductible status and allowed amounts to avoid unexpected out-of-pocket expenses.