Breathing treatment (nebulizer)
Facility: Wamego Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $13
- Cash Discount Price: $123
- vs. Medicare Baseline: 0.06x 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 |
|---|---|---|
| UnitedHealthcare | $10 | 4% |
| Aetna | $10 | 4% |
| Medicaid / KanCare | $10 | 4% |
| Providrs Care | $16 | 7% |
| Tricare | $35 | 16% |
| Blue Cross Blue Shield | $334 - $351 | 149% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment using a nebulizer, the facility cash price is $123.00, which is significantly lower than the Medicare benchmark of $223.72. This aligns with the principle that commercial negotiated rates often average 200% to 300% of Medicare, whereas fair pricing typically sits between 120% and 150%. In this case, the cash rate represents a substantial discount compared to the federal baseline, illustrating how paying out-of-pocket can sometimes be more cost-effective than relying on insurance, particularly for patients with high deductibles. While the facility is a Critical Access Hospital in Wamego, KS, serving Medicaid plans through KanCare, the specific negotiated rates for commercial payers like UnitedHealthcare and Aetna are not disclosed in this dataset, so direct comparisons to state or county averages for these specific insurers are not available.
Patients should be aware that while the cash price is competitive, insurance contracts often include administrative overheads that inflate the baseline price by 20% to 40%. If you have insurance, it is crucial to verify your deductible status before scheduling, as you may still be responsible for the full negotiated amount if you haven't met your out-of-pocket threshold. Additionally, many facilities offer prompt-pay discounts of 20% to 50% for upfront payment, which can further reduce the final cost by bypassing expensive claims processing fees. Before finalizing any payment, we recommend requesting a detailed, itemized bill to ensure there are no errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected through a