Breathing treatment (nebulizer)
Facility: Mitchell County Hospital Health Systems
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $71
- Cash Discount Price: $71
- vs. Medicare Baseline: 0.32x 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 | $42 | 19% |
| Triwest Well Mark All Plans | $45 - $89 | 20% |
| First Health-All Plans | $48 - $94 | 21% |
| Pref Hlth Care Sytms Comm - All Plans | $48 - $94 | 21% |
| Aetna | $48 - $94 | 21% |
| UnitedHealthcare | $50 - $224 | 22% |
| Auxiant-All Plans | $50 - $100 | 22% |
| Phc Leased Ntwrk Access - All Plans | $50 - $100 | 22% |
| Multiplan Ppo - All Plans | $50 - $100 | 22% |
| Cigna | $52 - $104 | 23% |
| Health Partners Ks-All Plans | $52 - $104 | 23% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the facility's cash median rate is $71.00, which is lower than the negotiated rates paid by most insurance plans in this dataset. While the facility's cash price is notably lower than the gross charge of $79.00, patients with high-deductible plans may find that paying out-of-pocket is more cost-effective than using insurance, as many commercial payers have negotiated rates ranging from $42 to $224. It is important to note that while the facility is a Critical Access Hospital in Beloit, KS, with a government-local ownership structure, the specific negotiated rates vary significantly by insurer, with UnitedHealthcare showing the widest range from $50 to $224. Consumers should verify their specific plan's allowed amount before scheduling, as assuming in-network status guarantees the lowest price can lead to unexpected costs if the insurer's contract rate exceeds the cash price.
Patients should be aware of the potential for balance billing if they receive care from out-of-network providers, though the No Surprises Act generally protects against surprise bills for emergency services at in-network facilities. Even when using insurance, it is advisable to request an itemized billing audit to ensure no errors, double-billing, or unbundled codes are present, as over 80% of hospital bills contain inaccuracies that can be corrected. Additionally, patients can often reduce their out-of-pocket expenses by asking the hospital about "self-pay" or "prompt-pay" discounts, which typically range from 20% to 50% off the total bill if paid in full upfront. This strategy bypasses the administrative overhead