Breathing treatment (nebulizer)
Facility: Osborne County Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $51
- Cash Discount Price: $49
- vs. Medicare Baseline: 0.23x 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 |
|---|---|---|
| UnitedHealthcare | $37 - $123 | 17% |
| Health Partners Of Kansas | $42 - $139 | 19% |
| Wppa | $47 - $154 | 21% |
| Blue Cross Blue Shield | $48 - $159 | 21% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Osborne County Memorial Hospital in Osborne, KS, the facility's cash median price is $49.00. This cash rate is notably lower than the facility's gross charge of $57.00 and sits below the negotiated rates paid by major payers such as UnitedHealthcare ($37–$123), Health Partners Of Kansas ($42–$139), Wppa ($47–$154), and Blue Cross Blue Shield ($48–$159). While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds $49.00, as paying out-of-pocket could result in immediate savings compared to the administrative costs and potential deductibles associated with insurance claims.
When evaluating the cost against broader benchmarks, the Medicare amount for this service is $223.72, which serves as the objective baseline for fair pricing. The facility's cash rate of $49.00 represents a significant discount relative to the Medicare benchmark, illustrating that commercial negotiated rates often average between 200% and 300% of Medicare, while fair pricing is typically defined as 120% to 150%. Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, meaning they should not pay surprise bills for out-of-network ancillary services without first disputing the claim. Additionally, since over 80% of hospital bills contain