Breathing treatment (nebulizer)
Facility: Scott County Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $122
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.55x 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 |
|---|---|---|
| Humana | $55 | 25% |
| UnitedHealthcare | $69 - $125 | 31% |
| Wppa | $79 - $1,200 | 35% |
| Aetna | $119 | 53% |
| Blue Cross Blue Shield | $254 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Scott County Hospital in Scott City, KS, the facility's negotiated rates range from $55 to $1,200 depending on the insurance plan. While the median negotiated amount is $122, commercial payers like UnitedHealthcare and WPPA show significant variation, with some plans paying up to $1,200. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and its pricing is benchmarked against the national average, where commercial rates typically sit between 200% and 300% of the Medicare amount of $223.72. Because the facility is in-network, patients are protected from balance billing for emergency services under the No Surprises Act, though out-of-network ancillary services like certain lab tests could still result in unexpected charges if not carefully reviewed.
Patients should consider that cash-pay rates are not listed for this service, but asking for a prompt-pay discount before scheduling can often reduce the bill by 20% to 50% by bypassing insurance claim processing fees. Since the facility is a Critical Access Hospital, it may offer self-pay or prompt-pay incentives that are not automatically applied when insurance is on file; requesting a waiver of insurance submission at registration can help secure these lower rates. Although the data does not provide specific cash or state/county average comparisons for this code, understanding that commercial negotiated rates often exceed the true cost basis helps patients evaluate whether their specific plan's allowed amount aligns with fair market value. Always verify your deductible status and request an itemized bill to ensure no unbundled codes or services