Breathing treatment (nebulizer)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $118
- Cash Discount Price: $144
- 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 |
|---|---|---|
| Humana | $49 - $118 | 22% |
| Tricare | $53 - $127 | 24% |
| Va Ccn - All Plans | $62 - $149 | 28% |
| UnitedHealthcare | $62 - $240 | 28% |
| Medicaid / KanCare | $62 - $240 | 28% |
| Aetna | $62 - $216 | 28% |
| Ambetter / Centene | $68 - $164 | 30% |
| Health Partners - All Plans | $95 - $228 | 42% |
| Healthy Blue Mcaid - All Plans | $100 - $240 | 45% |
| Blue Cross Blue Shield | $347 | 155% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median price of $144.00 is notably lower than the negotiated rates paid by most insurance plans, which range from $62 to $347 depending on the carrier. While the Medicare benchmark of $223.72 serves as a reliable baseline for fair pricing, commercial negotiated rates often exceed this by a significant margin, with some payers like Blue Cross Blue Shield charging the full list price of $347. Patients with high-deductible plans may find paying the cash price of $144.00 more cost-effective than relying on insurance, as the negotiated allowed amounts frequently surpass the cash rate. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill.
This service was rendered at Trego County Lemke Memorial Hospital in Wakeeney, Kansas, a Critical Access Hospital with government local ownership. The facility's pricing structure reflects standard market dynamics where administrative costs and contract terms influence the final price paid by insurers versus cash payers. Given that over 80% of hospital bills contain errors, consumers should request a detailed, itemized statement rather than accepting summary invoices to ensure no unbundled charges or services not rendered are included. If a balance bill arises from out-of-network ancillary services, patients are protected under the No Surprises Act and should dispute the amount with their insurer rather than paying immediately. Always verify your specific plan's deductible status and network tier before scheduling to avoid unexpected costs.