Breathing treatment (nebulizer)
Facility: Amberwell Atchison Association
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $210
- Cash Discount Price: $317
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| Triwest - All Plans | $14 - $195 | 6% |
| Humana | $18 - $266 | 8% |
| Ambetter / Centene | $21 - $303 | 9% |
| Cigna | $23 - $326 | 10% |
| Aetna | $23 - $326 | 10% |
| Centrus Health Direct - All Plans | $31 - $444 | 14% |
| Oscar - All Plans | $31 - $444 | 14% |
| Multiplan - All Plans | $32 - $462 | 14% |
| Wppa Providrs Care - All Plans | $37 - $533 | 17% |
| Va Ccn - All Plans | $195 | 87% |
| Superior Select Mcr Adv - All Plans | $195 - $224 | 87% |
| UnitedHealthcare | $195 - $1,062 | 87% |
| Blue Cross Blue Shield | $241 - $254 | 108% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the cash price at Amberwell Atchison Association is $317.00. This cash rate is identical to the facility's median negotiated rate of $317.00, which is notably higher than the state of Kansas average of $195.00. While commercial payers like UnitedHealthcare and UnitedHealthcare negotiate rates up to $1,062, the cash price remains the lowest option for patients without insurance. Because commercial negotiated rates often include administrative overhead and can exceed cash prices, individuals with high-deductible plans may find paying out-of-pocket cheaper than relying on insurance coverage for this specific service.
Patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the $317.00 cash rate. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, unexpected ancillary services or emergency care could still trigger additional charges if not carefully reviewed. To ensure accuracy, consumers should request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By comparing the facility's rates directly to the Medicare benchmark of $223.72 and seeking written confirmation of all discounts, patients can avoid surprise costs and make informed financial decisions regarding their care.