Breathing treatment (nebulizer)
Facility: Ellsworth County Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $53
- Cash Discount Price: $53
- vs. Medicare Baseline: 0.24x 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 | $25 - $258 | 11% |
| Healthy Blue Mcr Adv | $25 - $258 | 11% |
| Humana | $25 - $391 | 11% |
| Triwest -All Plans | $25 - $258 | 11% |
| First Health - All Plans | $26 - $371 | 12% |
| Aetna | $26 - $371 | 12% |
| UnitedHealthcare | $28 - $412 | 13% |
| Cigna | $28 - $391 | 13% |
| Coventry Mcaid-All Plans | $29 - $412 | 13% |
| Medicaid / KanCare | $29 - $412 | 13% |
| Healthy Blue Mcaid- All Other Plans | $29 - $412 | 13% |
| Blue Cross Blue Shield | $39 - $41 | 17% |
| Providers Care-Wppa-All Plans | $44 - $618 | 20% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment using a nebulizer, the cash price at Ellsworth County Medical Center is $53.00, which matches the facility's negotiated rate and the cash median for this service. This amount is significantly lower than the Medicare benchmark of $223.72, indicating a fair pricing structure relative to the federal cost baseline. While the facility is a Critical Access Hospital in Ellsworth, Kansas (ZIP 67439), the specific cash price provided does not include explicit comparisons to broader state or county averages for this procedure. However, patients should note that commercial negotiated rates for this service vary widely among payers, ranging from a low of $25 to a high of $618 across 13 different plans, with most commercial rates exceeding the cash price due to administrative overhead and contract structures.
Patients with high-deductible plans may find paying the $53.00 cash price more advantageous than relying on insurance, as many commercial negotiated rates exceed this amount. To maximize savings, it is recommended to explicitly request a "self-pay" or "prompt-pay" discount before scheduling the service, as these upfront payment incentives can reduce the final bill by 20% to 50%. If you receive an itemized bill, ensure it breaks down the specific CPT code to avoid confusion with bundled charges or unbundled components, and always verify that no services were rendered before agreeing to pay. For any disputes regarding billing accuracy, a formal written audit request should be sent to the billing supervisor rather than relying on verbal assurances.