Breathing treatment (nebulizer)
Facility: Holton Community Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $246
- Cash Discount Price: $263
- vs. Medicare Baseline: 1.10x 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 | $26 - $440 | 12% |
| UnitedHealthcare | $26 - $440 | 12% |
| Humana | $27 - $236 | 12% |
| Kansas Superior Select - All Plans | $27 - $238 | 12% |
| Blue Cross Blue Shield | $41 - $1,010 | 18% |
| Preferred Health Freedom | $42 - $365 | 19% |
| Preferred Health Professionals | $42 - $365 | 19% |
| Preferred Health Fn Select - All Other Plans | $42 - $365 | 19% |
| Wppa Providers - All Plans | $48 - $418 | 21% |
| Medicaid / KanCare | $50 - $440 | 22% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Holton Community Hospital in Holton, Kansas, the facility's cash median rate is $263.00, which is notably lower than the negotiated rates charged to most insurance plans. While the facility's cash price is significantly below the gross chargemaster of $351.00, many commercial payers, including Aetna and UnitedHealthcare, negotiate rates as high as $440.00, creating a scenario where paying out-of-pocket may result in substantial savings compared to using insurance. This price disparity highlights the importance of verifying your specific plan's negotiated rate before scheduling, as commercial contracts often include administrative overheads that inflate the final bill beyond the true cost of care.
The facility's cash median of $263.00 also compares favorably against the Medicare benchmark of $223.72, with a ratio indicating the cash price is approximately 117% of the Medicare rate, suggesting a fair pricing structure relative to federal standards. However, patients should be aware that while the No Surprises Act protects against balance billing for emergency services at in-network facilities, it does not automatically eliminate all unexpected costs for non-emergency procedures or ancillary services. To ensure you receive the most accurate pricing, it is recommended to request a self-pay or prompt-pay discount directly from the hospital prior to any visit, as these upfront payment incentives can further reduce the total amount owed and bypass the complex claims processing associated with insurance billing.