Breathing treatment (nebulizer)
Facility: Lincoln County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $254
- Cash Discount Price: $50
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Blue Cross Blue Shield | $254 - $1,800 | 114% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment (nebulizer) at Lincoln County Hospital in Lincoln, KS, the cash median price is $50.00, which is significantly lower than the facility's negotiated rate of $254.00. While the facility is in-network for Blue Cross Blue Shield, the negotiated rate range for this service spans from $254 to $1,800, meaning patients with high-deductible plans might save money by paying the cash price directly, provided they have no other coverage. It is important to note that the facility is a Critical Access Hospital with government-local ownership, and while the cash rate is competitive, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling to ensure they are receiving the lowest possible fee.
The Medicare benchmark for this service is $223.72, which serves as a reliable baseline for evaluating the facility's pricing structure. The cash price of $50.00 is notably lower than the Medicare amount, whereas the negotiated rate of $254.00 exceeds the Medicare benchmark by approximately 13% (a ratio of 1.1). Because the cash price is already below the Medicare rate, there is little financial advantage to using insurance for this specific procedure unless the patient has a high deductible that prevents them from accessing the cash rate. Consumers should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, but if a patient chooses to pay out-of-network or encounters unexpected ancillary charges, they should request an itemized billing audit to identify any unbundled codes or services not rendered before agreeing to pay the full amount.