Breathing treatment (nebulizer)
Facility: Greeley County Health Services
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $10
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.04x 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 |
|---|---|---|
| Aetna | $10 | 4% |
| Medicaid / KanCare | $10 | 4% |
| Blue Cross Blue Shield | $54 | 24% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment via nebulizer, Greeley County Health Services in Tribune, KS, lists a cash median price of $42.00 and a median negotiated rate of $10.00. While the facility is a Critical Access Hospital owned by the local government, the data indicates that the cash price is significantly higher than the negotiated rate paid by insurance plans like Aetna, Medicaid/KanCare, and Blue Cross Blue Shield. In many cases, patients with high-deductible plans may find paying the cash price of $42.00 more cost-effective than relying on insurance, especially if the insurer's negotiated rate exceeds the cash amount or if the patient has not yet met their deductible. It is important to verify your specific plan's allowed amount before scheduling, as commercial rates can vary widely even within the same network.
This procedure falls under the category of balance billing risks if care is received from an out-of-network provider, though the No Surprises Act generally protects patients from such surprise bills for emergency services and non-emergency care at in-network facilities. If you do receive a bill for the difference between the provider's chargemaster and your insurance payment, you should not pay immediately out of fear of credit damage; instead, dispute the bill with your insurer and request a No Surprises Act audit. Additionally, since hospitals issue summary bills that can obscure individual charges, you should demand a full itemized statement before agreeing to any payment plan. Finally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final cost by 20% to 50% if you settle the account upfront, bypassing the administrative costs associated