Breathing treatment (nebulizer)
Facility: Kiowa County Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $285
- Cash Discount Price: $272
- vs. Medicare Baseline: 1.27x 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 Of Ks-All Plans | $18 - $282 | 8% |
| UnitedHealthcare | $21 - $434 | 9% |
| Medicaid / KanCare | $21 - $320 | 9% |
| Providrs Care/Wppa-All Plans | $32 - $480 | 14% |
| Blue Cross Blue Shield | $42 - $445 | 19% |
| Aetna | $285 - $445 | 127% |
| Medica Prime Mcare Cost-All Plans | $285 - $445 | 127% |
| Humana | $285 - $445 | 127% |
| Celtic Comml Exchange-All Other Plans | $285 - $445 | 127% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Kiowa County Memorial Hospital in Greensburg, KS, lists a cash median price of $272.00 and a median negotiated rate of $285.00. While the facility is a Critical Access Hospital owned by the local government, the data indicates that commercial insurance plans typically pay between $21 and $480 for this service, with most major payers like UnitedHealthcare and Medicaid/KanCare settling around $285.00. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans, as the cash price of $272.00 is lower than the standard insurance negotiated amount. Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can often reduce the final bill further than the listed cash median.
The facility's pricing is evaluated against a Medicare benchmark of $223.72, which serves as a scientifically validated baseline for the true cost of care. The cash price of $272.00 represents a markup of 1.3 times the Medicare rate, while the negotiated rate of $285.00 exceeds the Medicare amount by 27.8%. Given that over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill to ensure no unbundled codes or services not rendered are included. If a patient receives a balance bill for the difference between the provider's rate and their insurance allowed amount, they may be protected under the