Breathing treatment (nebulizer)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $30
- Cash Discount Price: $46
- vs. Medicare Baseline: 0.13x 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 | $19 - $41 | 8% |
| UnitedHealthcare | $23 - $30 | 10% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment via nebulizer, the facility's cash median rate is $46.00, which matches the cash median for the state of Kansas. While the facility is a Critical Access Hospital in Marysville, KS, the negotiated rates paid by major payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield range from $19 to $254, significantly higher than the cash price. This disparity highlights a common billing scenario where commercial insurance negotiated rates can exceed cash prices; patients with high-deductible plans may find it financially advantageous to pay the $46.00 cash rate directly, provided they have the funds available, as the insurance allowed amount often covers less than the full negotiated fee.
To ensure you are not overcharged, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the provider's chargemaster and your insurance payment, the No Surprises Act may protect you from balance billing for out-of-network services at in-network facilities, so you should dispute any unexpected charges immediately rather than paying them out of fear of credit damage. Additionally, ask the billing department about prompt-pay discounts, which can reduce the $46.00 cash price further by offering immediate liquidity incentives, ensuring you receive the most accurate and lowest possible rate for this procedure.