Breathing treatment (nebulizer)
Facility: Hodgeman County Health Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $269
- Cash Discount Price: $306
- vs. Medicare Baseline: 1.20x 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 |
|---|---|---|
| Blue Cross Blue Shield | $40 - $42 | 18% |
| Triwest - All Plans | $244 | 109% |
| Humana | $244 | 109% |
| UnitedHealthcare | $244 - $363 | 109% |
| Medicaid / KanCare | $244 - $382 | 109% |
| Aetna | $306 | 137% |
| First Health - All Plans | $344 | 154% |
| Wppa (Provdrscare) - All Plans | $363 | 162% |
| Health Partners - All Plans | $363 | 162% |
Consumer Guidance & Cost Commentary
For this breathing treatment (nebulizer) service at Hodgeman County Health Center in Jetmore, Kansas, the cash median price is $306.00, which is notably lower than the negotiated rates paid by most insurance plans. While the facility's cash price aligns with the cash median for the region, commercial payers like UnitedHealthcare and Medicaid/KanCare have negotiated rates ranging from $244 to $382, with UnitedHealthcare's range extending up to the gross charge of $382.00. Because commercial negotiated rates often include administrative overhead and contract premiums, patients with high-deductible plans may find paying the cash price of $306.00 more cost-effective than relying on insurance, especially if their plan's allowed amount exceeds the cash rate.
Patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than paying directly. It is important to note that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still request a full itemized bill to ensure no unbundled codes or services not rendered are included. Additionally, asking the facility about prompt-pay discounts before check-in can further reduce the final cost, as paying upfront bypasses the administrative fees and claim processing delays associated with insurance billing.