Breathing treatment (nebulizer)
Facility: Stanton County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $219
- Cash Discount Price: $57
- vs. Medicare Baseline: 0.98x 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 |
|---|---|---|
| Blue Cross Blue Shield | $59 - $254 | 26% |
| Healthy Blue Mcr Adv - All Other Plans | $61 - $238 | 27% |
| Healthy Blue Mcaid | $62 - $207 | 28% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Stanton County Hospital, the cash price is $57.00, which matches the facility's median negotiated rate of $60.00. This cash price is significantly lower than the Medicare benchmark of $223.72, indicating that paying out-of-pocket may offer substantial savings compared to standard insurance reimbursement. While the facility's negotiated rates for in-network payers like Blue Cross Blue Shield range from $59 to $254, these amounts are often inflated by administrative costs and contract structures. Patients with high-deductible plans should consider that paying the cash price of $57.00 upfront could be more cost-effective than relying on insurance, especially if their plan's negotiated rate exceeds this amount or if they have not yet met their deductible.
To maximize savings, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Since the facility is a Critical Access Hospital in Johnson, KS, and is government-owned, it is advisable to request an itemized billing audit before finalizing payment to ensure no errors or unbundled charges are present. Although the data does not provide specific county or state average comparisons for this procedure, the stark difference between the cash price and the Medicare benchmark highlights the importance of comparing rates against federal standards rather than the hospital's full chargemaster list. Always confirm your specific plan's allowed amount with the hospital prior to scheduling to avoid unexpected balance billing.