Breathing treatment (nebulizer)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $55
- Cash Discount Price: $58
- vs. Medicare Baseline: 0.25x 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 - $64 | 17% |
| Humana | $42 - $73 | 19% |
| Aetna | $43 - $80 | 19% |
| UnitedHealthcare | $44 - $76 | 20% |
| Hpk-All Plans | $44 - $76 | 20% |
| Medicaid / KanCare | $46 - $80 | 21% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the cash price at Medicine Lodge Memorial Hospital is $58.00, which matches the facility's median paid amount. This cash rate is significantly lower than the facility's negotiated rates, which range from $42.00 to $80.00 depending on the insurance carrier, with Tricare paying a median of $37.00 and Humana paying a median of $42.00. While the cash price is the lowest available option, patients with high-deductible plans should be aware that paying out-of-pocket might still result in higher total costs if their insurance deductible has not yet been met. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill.
The facility's pricing structure is evaluated against federal benchmarks, where the Medicare amount for this service is $223.72. The cash price of $58.00 represents a substantial discount relative to the Medicare rate, illustrating that commercial negotiated rates often exceed the true cost baseline established by federal reimbursement standards. Although the data does not provide specific state or county average figures for comparison, the facility operates as a Critical Access Hospital in Medicine Lodge, Kansas, and is owned by a Government Hospital District. Patients should request a detailed, itemized bill to ensure no errors exist, as over 80% of hospital bills contain discrepancies such as unbundled codes or services not rendered. If a balance bill arises from an out-of-network provider, the No Surprises Act may protect the patient from paying the