Breathing treatment (nebulizer)
Facility: Children'S Mercy South
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $119
- Cash Discount Price: $87
- vs. Medicare Baseline: 0.53x 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 | $73 - $174 | 33% |
| Blue Cross Blue Shield | $74 - $134 | 33% |
| Healthy Blue | $77 - $530 | 34% |
| Medicaid / KanCare | $81 | 36% |
| Cigna | $87 - $126 | 39% |
| Medica | $106 | 47% |
| Aetna | $109 - $123 | 49% |
| Nebraska Furniture Mart | $118 | 53% |
| Quiktrip | $118 | 53% |
| Centivo | $118 | 53% |
| Orscheln | $118 | 53% |
| Wppa Providrs Care | $118 | 53% |
| Health Midwest Comprehensive Care | $118 | 53% |
| Wellfit/Centrus | $118 | 53% |
| Humana | $120 | 54% |
| Coxhealth Network | $134 | 60% |
| Coventry Health Care Of Kansas | $134 | 60% |
| Mercy Health | $136 | 61% |
| Multiplan | $138 | 62% |
| American Healthcare Alliance | $154 | 69% |
| Healthlink | $159 | 71% |
| National Preferred Provider Network | $163 | 73% |
| Home State Health | $465 | 208% |
Consumer Guidance & Cost Commentary
For CPT code 94640, a breathing treatment using a nebulizer, Children's Mercy South in Overland Park, KS, lists a gross charge of $181.00. This amount is significantly higher than the Medicare benchmark of $223.72, which serves as the federal baseline for fair pricing. While the facility's cash price of $87.00 is lower than the Medicare rate, commercial insurance negotiated rates vary widely across payers, ranging from $73 to $465. For patients with high-deductible plans, paying the cash price of $87.00 upfront may be more cost-effective than relying on insurance, as some negotiated rates exceed the cash amount. It is important to verify your specific plan's allowed amount before scheduling, as in-network status does not guarantee the lowest possible price.
Patients should proactively inquire about self-pay or prompt-pay discounts before check-in, as these programs can offer substantial fee reductions by bypassing administrative claim processing costs. Since over 80% of hospital bills contain errors, requesting a detailed, itemized statement is essential to identify any unbundled codes or services not rendered. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still review their itemized bill to ensure accuracy. By comparing the facility's rates against the Medicare benchmark and understanding the mechanics of negotiated versus cash pricing, consumers can make informed decisions to minimize unexpected medical costs.