Breathing treatment (nebulizer)
Facility: Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $115
- Cash Discount Price: $143
- vs. Medicare Baseline: 0.51x 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 |
|---|---|---|
| Health Partners Of Kansas - All Plans | $1 - $275 | N/A |
| Preferred Healthcare-All Plans | $1 - $275 | N/A |
| Wppa/Providers Care-All Plans | $2 - $405 | 1% |
| Ambetter / Centene | $8 - $159 | 4% |
| Tricare | $8 - $145 | 4% |
| Humana | $26 - $145 | 12% |
| Medicare (plans) | $26 - $146 | 12% |
| Blue Cross Blue Shield | $41 - $44 | 18% |
| Coventry - All Other Plans | $47 - $260 | 21% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, "Breathing treatment (nebulizer)," Memorial Hospital in Abilene, KS, lists a cash price of $143.00, which matches the facility's median paid amount. This cash rate is significantly lower than the Medicare benchmark of $223.72, suggesting that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans or those without insurance. While the facility is a Critical Access Hospital owned by a Government Hospital District, the negotiated rates vary widely among payers; for instance, Blue Cross Blue Shield has a low range of $41 to $44, whereas Wppa/Providers Care ranges from $2 to $405. Patients should verify their specific plan's allowed amount, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures.
To avoid unexpected costs, consumers should proactively request a "self-pay" or "prompt-pay" discount before scheduling services, as these upfront payments can reduce the total bill by 20% to 50% by bypassing insurance claims processing. If a patient receives a bill after insurance submission, they should demand a full itemized audit to identify errors, double-billing, or unbundled codes, as over 80% of hospital bills contain inaccuracies. Furthermore, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, meaning any surprise charges should be disputed immediately with the insurer rather than paid out of pocket. Always compare the final allowed amount to the Medicare rate to ensure the facility is charging a fair price relative to the true cost of care