Breathing treatment (nebulizer)
Facility: Phillips County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $66
- Cash Discount Price: $53
- vs. Medicare Baseline: 0.30x 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 | $42 - $110 | 19% |
| Health Partners-All Plans | $43 - $110 | 19% |
| Blue Cross Blue Shield | $43 - $254 | 19% |
| Medicaid / KanCare | $43 - $110 | 19% |
Consumer Guidance & Cost Commentary
For a nebulizer breathing treatment at Phillips County Hospital in Phillipsburg, KS, the facility's cash price of $53.00 is notably lower than the state average of $85.00, making it a potentially cost-effective option for patients with high-deductible plans or those paying out-of-pocket. While the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $42 to $254, these amounts often exceed the cash price due to administrative overhead and contract structures. It is important to note that while the facility is a Critical Access Hospital with government local ownership, the cash rate of $53.00 represents a significant discount compared to the median paid amount of $85.00, suggesting that self-pay or prompt-pay discounts may be available if requested before scheduling.
To ensure you receive the best possible rate, we recommend verifying the facility's "self-pay" or "prompt-pay" discounts directly with the hospital, as these can reduce costs by 20% to 50% by bypassing insurance billing cycles. Although the No Surprises Act protects patients from balance billing for emergency care at in-network facilities, it is crucial to request an itemized billing audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. When evaluating the value of this service, compare the facility's rates against the Medicare benchmark of $223.72; while the commercial negotiated rates are lower than the gross chargemaster, they still represent a markup over the federal baseline, so always confirm your specific plan's allowed amount rather than assuming in-network status guarantees the lowest price.