Breathing treatment (nebulizer)
Facility: Fredonia Regional Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $126
- Cash Discount Price: $140
- vs. Medicare Baseline: 0.56x 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 | $46 - $254 | 21% |
| Veterans Programs - All Plans | $48 - $138 | 21% |
| UnitedHealthcare | $48 - $249 | 21% |
| Aetna | $48 - $244 | 21% |
| Cigna | $84 - $244 | 38% |
| Reserve National-All Plans | $84 - $244 | 38% |
| Meritain-All Plans | $84 - $244 | 38% |
Consumer Guidance & Cost Commentary
For this CPT code representing a breathing treatment (nebulizer) at Fredonia Regional Hospital in Kansas, the cash price is $140.00, which matches the facility's median negotiated rate. While the Medicare benchmark for this service is $223.72, commercial payers negotiate rates ranging from $46 to $254 depending on the plan. Patients with high-deductible plans may find the cash price of $140.00 more affordable than their insurance allowed amount, which could exceed the cash rate. It is important to note that while the facility is a Critical Access Hospital in a rural area, the negotiated rates vary significantly across the seven participating payers, with UnitedHealthcare and Aetna showing the widest ranges.
To minimize unexpected costs, patients should verify whether their specific plan has a deductible that has already been met before relying on insurance coverage, as this can result in paying the full negotiated rate. Additionally, since the facility is a government-owned Critical Access Hospital, patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final bill. If a balance bill arises from an out-of-network service, such as an ancillary lab or physician, patients should not pay immediately but instead request a formal itemized audit to identify unbundled codes or services not rendered, ensuring compliance with the No Surprises Act protections.