Breathing treatment (nebulizer)
Facility: Hamilton County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $49
- Cash Discount Price: $54
- vs. Medicare Baseline: 0.22x 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 | $8 - $200 | 4% |
| UnitedHealthcare | $10 - $190 | 4% |
| Blue Cross Blue Shield | $20 - $254 | 9% |
| Cigna | $23 - $190 | 10% |
| Aetna | $31 - $366 | 14% |
| First Health Coventry - All Plans | $40 - $170 | 18% |
Consumer Guidance & Cost Commentary
For this procedure, the cash price is $54.00, which matches the facility's cash median and is significantly lower than the Medicare benchmark of $223.72. While the facility is a Critical Access Hospital in Syracuse, KS, the data does not provide specific county or state average rates for comparison. It is important to note that commercial insurance plans often pay negotiated rates higher than the cash price; for instance, UnitedHealthcare's negotiated rate range is $10 to $190, and Aetna's range is $31 to $366. Patients with high-deductible plans may find it financially advantageous to pay the $54.00 cash price directly, as this avoids the substantial administrative markups and potential balance billing associated with insurance claims.
Before scheduling, patients should explicitly request a "self-pay" or "prompt-pay" discount from the billing department, as these upfront payment incentives can further reduce the final cost. If you choose to use insurance, be aware that the facility is out-of-network for the "Va Ccn - All Plans" payer, which carries a risk of balance billing if the No Surprises Act protections do not apply to this specific service. Conversely, for in-network payers like UnitedHealthcare and Cigna, the facility is contractually bound to the negotiated rates listed above. To ensure you receive the most accurate pricing, always verify your specific plan's network status and ask the hospital to confirm whether any additional fees or waivers are required before the visit.