Breathing treatment (nebulizer)
Facility: Stevens County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $271
- Cash Discount Price: $375
- vs. Medicare Baseline: 1.21x 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 |
|---|---|---|
| Humana | $50 - $237 | 22% |
| Aetna | $51 - $640 | 23% |
| First Health - All Plans | $122 - $576 | 55% |
| Wppa - All Plans | $128 - $608 | 57% |
| Medicaid / KanCare | $135 - $640 | 60% |
| Blue Cross Blue Shield | $241 - $254 | 108% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Stevens County Hospital in Hugoton, KS, lists a cash price of $375.00, which matches the facility's cash median. This cash rate is significantly higher than the state average, as the median paid amount across payers is $237.00, and the negotiated median is $271.00. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs than direct cash payment. If a patient has a high-deductible plan, paying the cash price of $375.00 upfront may be more cost-effective than relying on an insurance negotiated rate that could exceed this amount, provided the patient has not yet met their deductible.
To minimize costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% when paid in full before or shortly after the service. It is also important to verify that the specific insurance plan is in-network, as in-network status does not guarantee the lowest possible rate, and some facilities charge significantly more than others for the same procedure. Finally, if a bill is received, patients should request a detailed, itemized statement to review every line item for potential errors, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute.