Breathing treatment (nebulizer)
Facility: Smith County Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $101
- Cash Discount Price: $110
- vs. Medicare Baseline: 0.45x 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 | $41 | 18% |
| Medicaid / KanCare | $66 - $250 | 30% |
| Multiplan-All Plans | $86 - $225 | 38% |
| Wppa-All Plans | $89 - $235 | 40% |
| Health Partners Of Ks Ppo-All Plans | $90 - $238 | 40% |
| UnitedHealthcare | $90 - $238 | 40% |
| Midlands Choice-All Plans | $90 - $238 | 40% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Smith County Memorial Hospital in Smith Center, KS, lists a cash price of $110.00. This cash rate is notably lower than the facility's negotiated rates, which range from $86 to $238 across seven payers including Medicaid/KanCare and UnitedHealthcare. While the facility is a Critical Access Hospital with government-local ownership, the cash price aligns exactly with the cash median reported for this service. Patients with high-deductible plans may find this cash price advantageous, as it is significantly lower than the median negotiated amount of $142.00 paid by insurers. To secure this lower rate, patients should request a self-pay classification and prompt-pay discount before scheduling, ensuring the billing system does not automatically submit a claim to an insurance carrier.
When evaluating the cost relative to federal standards, the Medicare benchmark for this procedure is $223.72. The facility's cash price of $110.00 represents a 50% reduction compared to the Medicare amount, which is a common outcome for cash-pay services. Although the data does not provide specific state or county average figures for comparison, the facility's location in Smith County (ZIP 66967) and its status as a Critical Access Hospital are relevant factors in pricing. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is essential to verify that all ancillary services are covered under the plan. For the most accurate pricing, patients are encouraged to contact the hospital directly to confirm current self-pay rates and any