Breathing treatment (nebulizer)
Facility: Wilson Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $194
- Cash Discount Price: $143
- vs. Medicare Baseline: 0.87x 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 |
|---|---|---|
| Cigna | $14 - $292 | 6% |
| Aetna | $14 - $365 | 6% |
| UnitedHealthcare | $16 - $339 | 7% |
| Mulitplan-All Plans | $16 - $336 | 7% |
| Health Partners-All Plans | $16 - $336 | 7% |
| Blue Cross Blue Shield | $17 - $365 | 8% |
| Ambetter / Centene | $17 - $365 | 8% |
| Tricare | $193 - $194 | 86% |
| Humana | $193 - $194 | 86% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment (nebulizer) at Wilson Medical Center in Neodesha, KS, the facility's cash median price is $143.00, which is lower than the gross charge of $191.00. While the facility is a Critical Access Hospital with government-local ownership, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, the median negotiated rate across payers is $194.00, and individual payer ranges extend up to $365.00, meaning patients with high-deductible plans might save money by paying the cash price directly, provided they confirm the facility accepts cash payments and does not submit claims to their insurer.
To avoid unexpected costs, consumers should actively request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance billing cycles. Additionally, if you receive a bill, always demand a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal audit. Finally, when reviewing your bill, compare the allowed amount to the Medicare benchmark of $223.72; since commercial rates are often inflated relative to this federal baseline, understanding the difference between the chargemaster list and the Medicare rate helps you identify if you are being charged a fair market value or if a dispute is warranted.