Breathing treatment (nebulizer)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $50
- Cash Discount Price: $41
- vs. Medicare Baseline: 0.22x 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 | $32 - $56 | 14% |
| Blue Cross Blue Shield | $39 - $41 | 17% |
| Providers Care (Wppa)-All Plans | $61 - $98 | 27% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median rate is $41.00, while the median negotiated rate paid by insurance is $50.00. This specific service is provided at the Hospital District #6 Patterson Health Center in Anthony, Kansas, a Critical Access Hospital. The data indicates that for patients with high-deductible plans, paying the cash price of $41.00 may be more cost-effective than relying on insurance, as the negotiated rates from payers like UnitedHealthcare, Blue Cross Blue Shield, and Providers Care range from $32 to $98 depending on the specific plan. It is important to note that commercial rates often include administrative overhead and contract dynamics that can make them higher than the direct cash price, even though insurance contracts cap the billed amount to prevent balance billing for in-network services.
Patients should actively inquire about "self-pay" or "prompt-pay" discounts before scheduling care, as these upfront payment incentives can further reduce the final cost by bypassing the administrative fees associated with insurance claims processing. While the facility's cash rate is lower than the negotiated average, the data does not provide specific county or state average comparisons for this procedure, so local pricing benchmarks cannot be applied here. Regardless of the payment method, consumers are advised to request a full itemized bill to verify that no unbundled charges or services not rendered have been included, as summary bills often obscure individual line items. Additionally, if a patient receives care from an out-of-network provider at this facility, they may be protected under the No Surprises Act, which prohibits balance billing for emergency and non-emergency services, though they