CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lafayette Regional Health Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $92
  • Cash Discount Price: $213
  • vs. Medicare Baseline: 0.41x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lafayette Regional Health Center is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.41x the Medicare baseline. Located in 1500 State Street, Lexington, MO.
Cash / Self-Pay
$213

Average discount available for prompt cash payment at this facility.

Insurance Median
$92

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$223.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $223.72 (100%)
Cash / Self-Pay: $213 (95%)
Insurance Median: $92 (41%)
Cash: $213 (95% of Medicare)
Ins. Median: $92 (41% of 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.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Ambetter / Centene $40 18%
Nhc Advantage $40 18%
United $53 - $96 24%
Aetna $55 - $186 25%
Universal Healthcare $55 25%
Healthyblue $70 31%
Medicaid / KanCare $71 32%
Amerigroup $72 32%
Home State Health Plan $72 32%
Humana $72 - $92 32%
Unicare $72 32%
Blue Cross Blue Shield $81 - $213 36%
College Park Family Care Center $92 41%
Oha Network $107 48%
Oscar $107 48%
Cigna $122 - $152 55%
Wppa Providrs Care Network $160 72%
Multiplan $166 74%
Coventry $170 76%
Coventry Kc Mo $170 76%
Cco, Inc. $181 81%
Corvel Corporation $181 81%
Focus Healthcare Mgmt, Inc $192 86%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1500 State Street, Lexington, MO 64067
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Critical Access Hospitals