Breathing treatment (nebulizer)
Facility: Nemaha Valley Community Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $59
- Cash Discount Price: $72
- vs. Medicare Baseline: 0.26x 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 |
|---|---|---|
| Va Ccn - All Plans | $30 - $40 | 13% |
| Humana | $30 - $40 | 13% |
| Aetna | $31 - $329 | 14% |
| Celtic Comm Exch - All Plans | $33 - $329 | 15% |
| Partners Direct Health - All Plans | $36 - $47 | 16% |
| Multiplan - All Plans | $62 - $81 | 28% |
| Health Partners - All Plans | $66 - $86 | 30% |
| Midlands Choice - All Plans | $66 - $86 | 30% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Nemaha Valley Community Hospital in Seneca, KS, lists a gross charge of $80.00. While the facility's cash median rate is $72.00, commercial insurance negotiated rates vary significantly by payer, ranging from $30 to $329 across nine different plans. Notably, the highest negotiated rate of $254 comes from Blue Cross Blue Shield, which is substantially higher than the facility's cash price. This disparity highlights that for patients with high-deductible plans or those without insurance, paying the cash median of $72.00 directly may result in lower out-of-pocket costs compared to the allowed amounts charged by many commercial insurers.
To minimize potential financial exposure, patients should verify their specific plan's negotiated rate before scheduling, as commercial rates often exceed cash prices due to administrative overhead and contract dynamics. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the costly insurance claims processing cycle. It is also important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services are not covered under the same network agreement. Finally, if a bill is received, patients are advised to request a full itemized audit to ensure all charges are accurate and to dispute any errors before payment.