Breathing treatment (nebulizer)
Facility: Clara Barton Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $58
- Cash Discount Price: $50
- vs. Medicare Baseline: 0.26x 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 |
|---|---|---|
| 6 Degrees Health - All Plans | $24 - $128 | 11% |
| Wppa-All Plans | $27 - $146 | 12% |
| Aetna | $31 - $165 | 14% |
| UnitedHealthcare | $31 - $165 | 14% |
| Hlth Partners Of Ks-All Plans | $31 - $168 | 14% |
| Phcs - All Plans | $31 - $165 | 14% |
| Blue Cross Blue Shield | $41 | 18% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Clara Barton Hospital in Hoisington, KS, lists a gross charge of $72.00. While the facility's cash median price is $50.00, which is lower than the gross charge, the negotiated rates paid by major insurers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield range from $31 to $168. It is important to note that these negotiated rates often exceed the cash price; for patients with high-deductible plans, paying the cash price of $50.00 upfront may result in significant savings compared to the insurance allowed amount, provided the patient's deductible has been met. Additionally, the facility offers a prompt-pay discount for those who settle their bill in full, which can further reduce the final cost.
When evaluating the value of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's inflated gross charge. The Medicare amount for this procedure is $223.72, which serves as the objective baseline for fair pricing. The facility's cash price of $50.00 is significantly lower than the Medicare rate, indicating a substantial markup on the commercial side. Furthermore, while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware of balance billing protections. Under the No Surprises Act, patients are generally protected from being billed the difference between the negotiated rate and the cash price for out-of-network services at in-network facilities, and they should never sign away their rights to dispute such bills without first requesting an itemized audit.