Breathing treatment (nebulizer)
Facility: Kiowa District Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $101
- Cash Discount Price: $81
- vs. Medicare Baseline: 0.45x 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 |
|---|---|---|
| Tricare | $37 - $275 | 17% |
| Blue Cross Blue Shield | $41 | 18% |
| UnitedHealthcare | $77 - $275 | 34% |
| Health Partners Of Ks-All Plans | $84 - $93 | 38% |
| Humana | $87 - $275 | 39% |
| Gbs Insurance - All Plans | $90 - $100 | 40% |
| Multiplan-All Plans | $90 - $100 | 40% |
| Aetna | $91 - $275 | 41% |
| Triwest-All Plans | $91 - $275 | 41% |
| Medicare (plans) | $91 - $265 | 41% |
| Medicaid / KanCare | $96 - $261 | 43% |
| Providers Care (Wppa)-All Plans | $144 - $159 | 64% |
| Liberty Healthshare-All Plans | $155 - $467 | 69% |
| Healthchoice-All Plans | $285 | 127% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment using a nebulizer at Kiowa District Hospital in Kiowa, Kansas, the facility's cash median price is $81.00, while the median negotiated rate across all payers is $101.00. This suggests that for patients with high-deductible plans or those without insurance, paying cash directly may result in lower out-of-pocket costs compared to using an insurance plan, as the negotiated rates often exceed the cash price. The facility, a Critical Access Hospital owned by a government hospital district, lists a gross charge of $101.00, which aligns with the median negotiated rate, indicating that most commercial payers are paying close to the listed price for this service.
When comparing pricing to federal benchmarks, the Medicare amount for this procedure is $223.72. While commercial negotiated rates typically average between 200% and 300% of Medicare rates, the data here shows a median negotiated rate of $101.00, which is significantly lower than the Medicare benchmark of $223.72, suggesting a favorable rate structure for in-network members. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected ancillary services could still trigger additional charges. To minimize costs, patients are encouraged to request a self-pay or prompt-pay discount before scheduling, as paying the full bill upfront can often reduce the total amount owed by 20% to 50%.