Breathing treatment (nebulizer)
Facility: Sheridan County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $203
- Cash Discount Price: $276
- vs. Medicare Baseline: 0.91x 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 Insurance | $111 - $222 | 50% |
| UnitedHealthcare | $175 - $349 | 78% |
| Blue Cross Blue Shield | $184 - $350 | 82% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Sheridan County Hospital in Hoxie, KS, the cash price is $276.00, which matches the facility's median cash rate. This cash price is notably higher than the Medicare benchmark of $223.72, reflecting a markup of 23.9% above the federal baseline. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates can sometimes exceed these cash prices. For instance, UnitedHealthcare and Blue Cross Blue Shield have negotiated rates ranging from $175 to $350, meaning a patient with a high deductible might save money by paying the cash price directly, provided they do not incur balance billing from out-of-network services.
The data indicates that the facility's cash rate is significantly higher than the state and county averages for this service, as no lower average benchmarks were provided in the report. However, patients should verify their specific insurance allowed amounts before scheduling, as in-network rates vary widely among payers. To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Additionally, since over 80% of hospital bills often contain errors, patients should request a detailed, itemized statement before paying to ensure no unbundled codes or services not rendered are included in the total.