Breathing treatment (nebulizer)
Facility: Bob Wilson Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $224
- Cash Discount Price: $108
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Medicare (plans) | $86 | 38% |
| Aetna | $86 - $215 | 38% |
| Humana | $86 | 38% |
| UnitedHealthcare | $86 - $224 | 38% |
| Kansas Health | $86 | 38% |
| Centura Employee Plan | $134 | 60% |
| Multiplan | $242 - $250 | 108% |
| Health Partners Of Kansas | $253 | 113% |
| Wppa | $255 | 114% |
| Blue Cross Blue Shield | $339 | 152% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, the gross charge at Bob Wilson Memorial Hospital in Ulysses, KS, is $269.00. While the facility's cash median price is $108.00, which is significantly lower than the Medicare benchmark of $223.72, commercial insurance negotiated rates vary widely among the ten payers listed. For instance, Aetna, UnitedHealthcare, and Multiplan have negotiated ranges extending up to $250, whereas Medicare and Kansas Health have fixed rates of $86. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $108.00 directly, as this amount is lower than the negotiated rates charged by several major insurers. It is important to note that while the facility is a Critical Access Hospital owned by a voluntary non-profit church, the specific negotiated rates depend entirely on the individual insurance plan's contract with the hospital.
To ensure you are not overcharged, it is recommended to 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. If you are an out-of-network patient receiving care at this in-network facility, the No Surprises Act generally protects you from balance billing for emergency and non-emergency services, though you should verify your specific situation with the billing department. Additionally, ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by 20% to 50% if paid in full upfront, bypassing the administrative costs