Breathing treatment (nebulizer)
Facility: Cloud County Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $119
- Cash Discount Price: $101
- vs. Medicare Baseline: 0.53x 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 |
|---|---|---|
| Pponext-All Plans | $1 - $275 | N/A |
| Mpi-All Plans | $1 - $275 | N/A |
| Aetna | $1 - $269 | N/A |
| Health Partners - All Plans | $1 - $275 | N/A |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Cloud County Health Center in Concordia, KS, the facility's cash median price is $101.00, which is lower than the state average of $155.00. While the facility's negotiated rates with major payers like Aetna and Pponext range between $1 and $275, these amounts often exceed the cash price, making self-pay a potentially more economical option for patients with high-deductible plans. It is important to note that commercial insurance contracts typically include administrative overheads that can inflate the baseline price by 20% to 40% compared to direct cash payments, and patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
The facility's Medicare benchmark rate for this service is $223.72, which serves as a scientifically validated baseline for evaluating pricing markups. Although the facility is a voluntary non-profit Critical Access Hospital, the gross charge of $125.00 is significantly lower than the Medicare amount, suggesting a transparent pricing structure that aligns closer to fair value than typical commercial markups. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is still advisable to request a formal itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, inquiring about prompt-pay discounts prior to check-in can further reduce costs by bypassing the administrative fees associated with insurance claims processing.