Breathing treatment (nebulizer)
Facility: Hiawatha Community Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $256
- Cash Discount Price: $317
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Oscar - All Plans | $31 - $444 | 14% |
| Centrus Health Direct - All Plans | $31 - $444 | 14% |
| Aetna | $33 - $478 | 15% |
| Preferred Hlth - All Plans | $37 - $533 | 17% |
| Cigna | $39 - $562 | 17% |
| Wppa Providrs Care - All Plans | $39 - $562 | 17% |
| Midlands Choice - All Plans | $40 - $574 | 18% |
| Multiplan - All Plans | $40 - $574 | 18% |
| Healthy Blue Mcaid - All Plans | $41 - $592 | 18% |
| UnitedHealthcare | $219 - $509 | 98% |
| Humana | $221 - $257 | 99% |
| Blue Cross Blue Shield | $241 - $254 | 108% |
| Ambetter / Centene | $263 - $270 | 118% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Hiawatha Community Hospital in Hiawatha, KS, lists a cash median price of $317.00, which matches the facility's gross charge. This cash rate is notably lower than the state average for this service, where commercial negotiated rates typically range from 200% to 300% of the Medicare benchmark of $223.72. While many in-network payers like UnitedHealthcare and Aetna have negotiated rates exceeding $200, the cash price offers a fixed baseline that can be more affordable for patients with high-deductible plans or those without insurance, provided they qualify for self-pay or prompt-pay discounts.
Patients should be aware that insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures, even though these rates protect members from balance billing. For instance, while UnitedHealthcare's allowed amount is $219 and Humana's is $221, the cash price of $317 remains competitive against the broader market where some out-of-network scenarios could theoretically result in higher charges absent federal protections like the No Surprises Act. To ensure the most accurate pricing, consumers are encouraged to request an itemized bill to verify that no unbundled codes or services not rendered are included, and to explicitly ask the billing department about available prompt-pay discounts before scheduling care.