Breathing treatment (nebulizer)
Facility: Logan County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $161
- Cash Discount Price: $33
- vs. Medicare Baseline: 0.72x 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 |
|---|---|---|
| Humana | $70 | 31% |
| Health Partners - All Plans | $157 | 70% |
| Medicaid / KanCare | $165 | 74% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Logan County Hospital in Oakley, KS, lists a cash median price of $33.00, which is significantly lower than the facility's negotiated rates of $161.00 and the highest commercial payer rate of $254.00. This substantial difference highlights a common billing dynamic where cash-pay options can be far more affordable than insurance-covered services, particularly for patients with high-deductible plans who may not yet have met their out-of-pocket thresholds. While the facility is a Critical Access Hospital owned by the local government, patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs and inflated negotiated rates associated with insurance billing.
It is important to note that the facility's cash rate of $33.00 is well below the Medicare benchmark of $223.72, suggesting a pricing structure that aligns closely with the true cost of care rather than the commercial markups often seen in private facilities. However, because this service is billed under a specific CPT code with a single payer plan per carrier, there are no county or state average figures available for direct comparison in this dataset. Regardless of the lack of regional averages, the disparity between the cash price and the maximum allowed amount of $254.00 indicates that patients with commercial insurance could potentially save hundreds of dollars by paying out-of-pocket, provided they have the necessary funds and verify that the cash rate is indeed the lowest available option before proceeding.