Breathing treatment (nebulizer)
Facility: Graham County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $111
- Cash Discount Price: $330
- vs. Medicare Baseline: 0.50x 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 |
|---|---|---|
| Celtic Commercial-All Other Plans | $2 - $272 | 1% |
| Medicare (plans) | $2 - $248 | 1% |
| Wppa (Providers Care)-All Plans | $2 - $314 | 1% |
| UnitedHealthcare | $2 - $314 | 1% |
| Blue Cross Blue Shield | $41 | 18% |
| Medicaid / KanCare | $111 | 50% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, "Breathing treatment (nebulizer)," Graham County Hospital in Hill City, KS, lists a cash price of $330.00, which matches the state average for this service. While Medicare covers this procedure at $223.72, commercial payers negotiate rates that vary significantly; for instance, Medicaid/KanCare and Blue Cross Blue Shield pay exactly $111.00, whereas UnitedHealthcare and Wppa (Providers Care) pay between $314.00 and $314.00. Because the cash price of $330.00 is lower than the negotiated rates for several major insurers, patients with high-deductible plans or those without insurance may save money by paying out-of-pocket directly, provided they confirm the facility's "self-pay" or "prompt-pay" discounts before scheduling.
It is important to note that the median amount paid by insurance for this service is $111.00, which is significantly lower than the cash price, yet still higher than the Medicare benchmark of $223.72 when adjusted for the facility's specific cost structure. The facility is a Critical Access Hospital owned by the local government, and while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. If a patient receives a bill exceeding the cash price, they should verify the code details and dispute any errors in writing, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal audit