Breathing treatment (nebulizer)
Facility: Lindsborg Community Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $119
- Cash Discount Price: $114
- 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 |
|---|---|---|
| Coventry Wc | $1 - $275 | N/A |
| Phcs Preferred-All Plans | $1 - $269 | N/A |
| Wppa-All Plans | $1 - $275 | N/A |
| Century Health-All Plans | $1 - $275 | N/A |
| Health Partners -All Plans | $1 - $275 | N/A |
| Multiplan-All Plans | $1 - $269 | N/A |
| Tricare | $24 - $136 | 11% |
| Coventry Mcr Adv | $25 - $137 | 11% |
| Blue Cross Blue Shield | $38 - $41 | 17% |
| Cigna | $44 - $246 | 20% |
| Coventry Comm-All Other Plans | $47 - $260 | 21% |
| UnitedHealthcare | $47 - $260 | 21% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median price is $114.00, which is lower than the Medicare benchmark of $223.72. While the facility's negotiated rates with major payers like Coventry and Cigna range from $1 to $275, the cash price offers a distinct advantage for patients with high-deductible plans or those without insurance, as it avoids the administrative markup inherent in commercial contracts. It is important to note that while the facility is a Critical Access Hospital in Lindsborg, KS, the specific county or state average for this procedure is not included in the provided data, so comparisons to regional norms cannot be made.
Patients should be aware that insurance negotiated rates often exceed cash prices due to the costs of claims processing and contract management, which can inflate the baseline price by 20% to 40%. To minimize costs, individuals should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the insurance billing cycle entirely. If a balance bill arises from an out-of-network service, such as an emergency physician or lab at an in-network facility, patients have the right to dispute the charge under the No Surprises Act rather than paying immediately out of fear. Always demand a full itemized CPT-coded bill before agreeing to any payment plan, as summary bills often obscure unbundled charges or services not rendered.