Breathing treatment (nebulizer)
Facility: Republic County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $44
- Cash Discount Price: $37
- vs. Medicare Baseline: 0.20x 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 |
|---|---|---|
| Rural Carriers-All Plans | $39 - $42 | 17% |
| Aetna | $41 - $44 | 18% |
| Meritain-All Plans | $41 - $44 | 18% |
| UnitedHealthcare | $42 - $45 | 19% |
| First Health-All Plans | $44 - $47 | 20% |
| Cigna | $44 - $47 | 20% |
| Midlands Choice-All Plans | $44 - $47 | 20% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment via nebulizer, Republic County Hospital in Belleville, KS, has a cash median price of $37.00, which is lower than the facility's negotiated rate of $44.00. This cash price is also notably lower than the state of Kansas average for this service, where the median paid amount is $44.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find paying the $37.00 cash rate more cost-effective than relying on insurance, as the negotiated rate of $44.00 often exceeds the cash price. It is important to note that while the facility offers a cash option, patients should verify if their specific insurance plan covers this service and whether the negotiated rate applies, as commercial rates can sometimes be higher than the direct cash price due to administrative costs and contract dynamics.
The data indicates that Medicare reimburses for this procedure at $223.72, which serves as a benchmark for fair pricing, as commercial negotiated rates typically range between 200% and 300% of Medicare amounts. In this case, the facility's negotiated rate of $44.00 is significantly lower than the Medicare amount, suggesting a competitive pricing structure compared to the federal baseline. However, patients should remain vigilant regarding balance billing, which occurs when out-of-network providers bill the difference between the chargemaster rate and the insurance allowed amount. Although the No Surprises Act protects patients from balance billing for emergency care and non-emergency services at in-network facilities, it is still advisable to request an itemized billing audit to ensure