Breathing treatment (nebulizer)
Facility: Great Plains Of Sabetha
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $90
- Cash Discount Price: $95
- vs. Medicare Baseline: 0.40x 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 |
|---|---|---|
| Celtic Mcr Adv | $8 - $228 | 4% |
| Aetna | $8 - $442 | 4% |
| UnitedHealthcare | $9 - $438 | 4% |
| Celtic Comm Exchange-All Other Plans | $10 - $285 | 4% |
| Medicaid / KanCare | $10 - $438 | 4% |
| Great West Healthcare-All Plans | $27 - $372 | 12% |
| Century/Wppa/Providers-All Plans | $29 - $416 | 13% |
| Multiplan-Phcs-All Plans | $30 - $416 | 13% |
| Federated Mutual Ins-All Plans | $31 - $420 | 14% |
| Blue Cross Blue Shield | $39 - $438 | 17% |
| Cigna | $90 - $416 | 40% |
| Humana | $90 - $416 | 40% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, "Breathing treatment (nebulizer)," Great Plains Of Sabetha in Sabetha, KS, lists a cash price of $95.00, which matches the facility's cash median. This cash rate is significantly lower than the Medicare benchmark of $223.72, indicating that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $8 to $442, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients should verify their specific plan's allowed amount, as commercial negotiated rates can sometimes be higher than the cash price, making self-pay a strategic choice to minimize out-of-pocket expenses.
To ensure you receive the most accurate pricing, it is essential to request an itemized bill before finalizing payment, as summary bills can obscure individual charges and potential errors. If you proceed with insurance, remember that prompt-pay discounts of 20% to 50% may be available if you settle the balance upfront, bypassing the administrative costs associated with claims processing. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, though you must be vigilant about signing consent waivers that could inadvertently waive these protections. Always confirm with the billing department whether your specific plan qualifies for the cash price or if a prompt-pay discount can be applied to your insurance bill.