Breathing treatment (nebulizer)
Facility: Minneola District Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $57
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.25x 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 | $40 - $391 | 18% |
| Humana | $40 - $391 | 18% |
| Va Community Care Program-All Plans | $40 - $391 | 18% |
| Blue Cross Blue Shield | $42 | 19% |
| Providrs Care Network-All Plans | $51 - $168 | 23% |
| Corporate Plan Management-All Plans | $51 - $168 | 23% |
| Triwest-All Plans | $54 - $178 | 24% |
| Preferred Health Care (Coventry)-All Other Plans | $54 - $178 | 24% |
| Health Partners Of Kansas-All Plans | $57 - $188 | 25% |
| Aetna | $57 - $198 | 25% |
| Phc (Coventry) Leased Network | $57 - $188 | 25% |
| Medicaid / KanCare | $60 - $198 | 27% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median rate is $42.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is significantly below the gross chargemaster of $60.00, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds this amount. It is important to note that the facility's cash rate of $42.00 is lower than the state average for this service, though specific county averages were not provided in the data. To secure the lowest possible price, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative costs associated with insurance billing.
The data indicates that while the facility's cash rate is competitive, the negotiated rates vary widely among payers, ranging from $40 to $198. For instance, UnitedHealthcare and Humana have negotiated rates between $40 and $391, whereas Medicaid/KanCare rates are capped at $168. Because commercial negotiated rates often include administrative overhead and do not reflect the true cost of care, it is recommended to compare these figures against the Medicare benchmark of $223.72. Although the facility's cash rate is lower than the Medicare amount, patients should verify their specific plan's allowed amount to ensure they are not overpaying. If a patient receives a bill that appears to include charges for services not rendered or items that should be bundled, they should request a full itemized audit to identify potential errors before making a