Breathing treatment (nebulizer)
Facility: William Newton Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $24
- Cash Discount Price: $55
- vs. Medicare Baseline: 0.11x 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 |
|---|---|---|
| UnitedHealthcare | $10 - $326 | 4% |
| Ambetter / Centene | $10 - $362 | 4% |
| Blue Cross Blue Shield | $10 - $241 | 4% |
| Triwest- All Plans | $10 - $127 | 4% |
| Providrs Care Nexus | $17 - $222 | 8% |
| Providrs Care - All Other Plans | $20 - $254 | 9% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the cash price at William Newton Hospital in Winfield, KS, is $55.00. This cash rate aligns exactly with the facility's median paid amount, suggesting that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans, as the negotiated rates for in-network payers like UnitedHealthcare and Ambetter / Centene range significantly higher, from $10 to over $360 depending on the specific plan. While the facility is a Critical Access Hospital owned by the local government, patients should verify their specific plan's allowed amount before scheduling, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures.
To ensure you are not overcharged, it is advisable to request a full itemized bill rather than accepting a summary invoice, as hospitals may obscure individual line items or unbundled charges. Additionally, since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, you should dispute any unexpected bills that exceed your insurance allowed amount. Finally, do not assume the negotiated rate is the lowest possible price; many facilities offer prompt-pay discounts of 20% to 50% for upfront payment, which can further reduce the final cost compared to the standard cash price of $55.00.