Breathing treatment (nebulizer)
Facility: Golden Valley Memorial Hospital
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $204
- Cash Discount Price: $180
- vs. Medicare Baseline: 0.91x 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 |
|---|---|---|
| Home State Health | $191 - $3,080 | 85% |
| UnitedHealthcare | $191 - $2,910 | 85% |
| Aetna | $204 | 91% |
| Humana | $204 | 91% |
| Ambetter / Centene | $245 | 110% |
Consumer Guidance & Cost Commentary
For this Breathing treatment (nebulizer) at Golden Valley Memorial Hospital in Clinton, MO, the cash median rate is $180, which is lower than the facility's gross charge of $300 and the Medicare benchmark of $223.72. While the facility is a government-owned Acute Care Hospital with a rating of 3 stars, patients should note that commercial negotiated rates often exceed cash prices; for instance, UnitedHealthcare and Home State Health have negotiated ranges starting at $191, which can be higher than the $180 cash option. This dynamic is particularly relevant for patients with high-deductible plans, as paying the lower cash price upfront may result in immediate savings compared to the administrative load and higher rates associated with insurance claims.
The data indicates that the cash price of $180 is significantly lower than the facility's gross charge of $300, and while the exact state or county average is not provided in this specific transaction record, the facility's government ownership and prompt-pay potential offer opportunities for cost reduction. Patients should be aware that balance billing is generally protected against for in-network services at this facility under the No Surprises Act, but it is crucial to verify network status and request a waiver of insurance submission before check-in to avoid unexpected costs. Additionally, if a summary bill is received, consumers should demand a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through formal written disputes.