Breathing treatment (nebulizer)
Facility: Girard Medical Center
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $81
- Cash Discount Price: $82
- vs. Medicare Baseline: 0.36x 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 | $18 - $406 | 8% |
| Ambetter / Centene | $18 - $247 | 8% |
| Blue Cross Blue Shield | $18 - $254 | 8% |
| Kansas Superior Select-All Plans | $18 - $247 | 8% |
| Medicare (plans) | $18 - $247 | 8% |
| Humana | $18 - $247 | 8% |
| UnitedHealthcare | $18 - $247 | 8% |
| Multiplan-All Plans | $35 - $215 | 16% |
| Uhhis-All Plans | $36 - $220 | 16% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer at Girard Medical Center in Kansas, the facility's cash median price is $82.00, which is lower than the state average of $93.00. While the facility is a Critical Access Hospital owned by a government hospital district, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, the median negotiated rate across payers is $81.00, which is slightly lower than the cash price, but individual payer contracts can vary significantly; for example, Aetna plans range from $18 to $406, while UnitedHealthcare plans range from $18 to $247. If you have a high-deductible plan, paying the cash price of $82.00 upfront may be more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if your deductible has not yet been met.
To ensure you are receiving the best possible rate, it is essential to verify your specific plan's allowed amount before scheduling, as in-network status does not guarantee the lowest price. Many facilities offer prompt-pay discounts for patients who settle their bill in full within a short window, which can bypass the administrative costs associated with insurance claims processing. Additionally, under federal protections such as the No Surprises Act, you are generally shielded from balance billing for emergency services or non-emergency care at in-network facilities, though unexpected charges can still occur from out-of-network ancillary services like certain lab tests. We recommend requesting an itemized bill to review every line item for accuracy and asking the billing department directly