Breathing treatment (nebulizer)
Facility: Stafford County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $70
- Cash Discount Price: $70
- vs. Medicare Baseline: 0.31x 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 |
|---|---|---|
| Health Partners-All Plans | $62 - $428 | 28% |
| Va Ccn-All Plans | $65 - $450 | 29% |
| UnitedHealthcare | $65 - $450 | 29% |
| Medica Mcr- All Plans | $65 - $450 | 29% |
| Humana | $65 - $450 | 29% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the cash and negotiated rates at Stafford County Hospital are both $70.00. This price is notably lower than the state average for this service, which ranges from $62 to $450 across various payers. While the facility's cash price matches the median paid amount of $70.00, patients should be aware that commercial insurance negotiated rates for this procedure can vary significantly, with some plans ranging up to $450. In cases where a patient's insurance deductible has not been met, the cash price of $70.00 may be more affordable than the higher negotiated rates charged by insurers like Health Partners, UnitedHealthcare, or Humana.
To maximize savings, patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% for upfront payments. It is important to request these discounts before scheduling any appointments to ensure the billing system is set up for self-pay rather than automatic insurance submission, which could void the cash agreement. Additionally, since the facility is a Critical Access Hospital in Stafford, KS, with a government-local ownership structure, patients should verify their specific plan details to avoid unexpected balance billing, as federal protections under the No Surprises Act may apply to out-of-network services rendered at in-network facilities.