Breathing treatment (nebulizer)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $188
- Cash Discount Price: $104
- vs. Medicare Baseline: 0.84x 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 - $527 | 4% |
| Medicaid / KanCare | $10 | 4% |
| Aetna | $10 | 4% |
| Providrs Care | $16 | 7% |
| Tricare | $35 | 16% |
| Humana | $188 - $190 | 84% |
| Medicare (plans) | $188 - $192 | 84% |
| Va | $188 | 84% |
| Smarthealth | $263 | 118% |
| Blue Cross Blue Shield | $275 - $290 | 123% |
| Ambetter / Centene | $320 | 143% |
Consumer Guidance & Cost Commentary
For the CPT code 94640, representing a breathing treatment via nebulizer, Ascension Via Christi Hospital Manhattan, Inc. lists a gross charge of $261.00. While the facility offers a cash median price of $104.00, which is significantly lower than the negotiated rates paid by major payers like Humana ($188–$192) and Medicare ($188–$192), patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs due to administrative fees and network tiering. The facility's cash rate is notably lower than the state average for Kansas, where the median negotiated rate across all payers is $188.00. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $104.00 upfront may be more cost-effective than relying on insurance, which could require you to cover the full negotiated amount before reimbursement.
To ensure you are not overcharged, it is recommended to request a detailed itemized bill before finalizing payment, as summary bills often obscure individual line items and potential errors. If you receive a balance bill for the difference between the facility's chargemaster and your insurance allowed amount, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Additionally, you should verify if the hospital offers a prompt-pay discount, which could further reduce your cash bill by 20% to 50% if paid in full within 30 days. Always confirm your specific plan's allowed amount and deductible status with the hospital