Breathing treatment (nebulizer)
Facility: Clay County Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $140
- Cash Discount Price: $150
- vs. Medicare Baseline: 0.63x 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 | $41 - $237 | 18% |
| Wppa/Providrs Care- All Plans | $41 - $237 | 18% |
| Health Partners - All Plans | $42 - $242 | 19% |
| Multiplan- All Plans | $42 - $242 | 19% |
| UnitedHealthcare | $42 - $242 | 19% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Clay County Medical Center in Clay Center, KS, the cash median price is $150.00, which matches the facility's gross charge. This cash rate is notably lower than the state average for this procedure, as the median paid amount across payers is $94.00, while the median negotiated rate is $140.00. Patients with high-deductible plans may find paying the full cash price of $150.00 more cost-effective than using insurance, as the negotiated rates often exceed the cash amount. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's pricing is benchmarked against the Medicare rate of $223.72, which serves as the objective baseline for evaluating commercial markups. While the commercial negotiated rates average between 200% and 300% of the Medicare rate, fair pricing is typically defined as 120% to 150% of this federal standard. At Clay County Medical Center, the cash price of $150.00 represents approximately 67% of the Medicare amount, suggesting a more transparent pricing structure compared to typical commercial negotiations. 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, but they must still verify their specific plan details and avoid signing out-of-network cost waivers for mandatory