Breathing treatment (nebulizer)
Facility: St Luke Hospital & Living Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $36
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.16x 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 | $22 - $41 | 10% |
| Bluestem Pace | $22 - $41 | 10% |
| Kansas Department Of Health And Environment | $22 - $41 | 10% |
| Ambetter / Centene | $22 - $42 | 10% |
| Blue Cross Blue Shield | $22 - $41 | 10% |
| Va Ccn | $22 - $41 | 10% |
| UnitedHealthcare | $22 - $41 | 10% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's negotiated rates range between $22 and $42 across seven major payers, with a median negotiated amount of $36.00. This commercial pricing structure is significantly higher than the Medicare benchmark of $223.72, reflecting the administrative costs and contract dynamics inherent in insurance billing. While the facility is a Critical Access Hospital in Marion, KS, the data does not provide specific state or county average comparisons for this specific procedure, so patients should rely on the Medicare rate as a reliable baseline for understanding the true cost of care versus the inflated commercial charges.
Patients with high-deductible plans may find that paying the cash price directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price, which is not listed in this report. To maximize savings, 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 in full upfront. Additionally, if you have received a bill from an out-of-network provider or for services not rendered, you should request a formal itemized audit to identify errors or unbundled charges before making any payment, ensuring you are not paying for unnecessary services or balance billing that may be protected under federal laws.