Breathing treatment (nebulizer)
Facility: Mercy Hospital Columbus
Billing Code: 94640 (CPT)
- CPT Billing Code: 94640
- Insurance Median: $95
- Cash Discount Price: $69
- vs. Medicare Baseline: 0.42x 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 |
|---|---|---|
| Centivo Contracted [320505] | $1 | N/A |
| Humana | $7 - $101 | 3% |
| Medicaid / KanCare | $7 - $191 | 3% |
| Insurance System Inc Contracted [320465] | $46 | 21% |
| Health Systems Inc Contracted [320174] | $46 | 21% |
| Administrative Payor Contracted [320005] | $48 | 21% |
| Tricare | $77 | 34% |
| Halo Hcr Inc Hospice Contracted [320432] | $77 | 34% |
| UnitedHealthcare | $77 - $173 | 34% |
| Globalhealth Contracted [320145] | $77 | 34% |
| Mercy Mgd Behavioral Health Contracted [320259] | $77 | 34% |
| Medical Associates Health Contracted [320444] | $77 | 34% |
| Centurion Of Missouri [20459] | $77 | 34% |
| Halo Hcr Inc Hospice [20432] | $77 | 34% |
| Novasys Contracted [320285] | $77 | 34% |
| Indian Health Service Contracted [320198] | $77 | 34% |
| Blue Cross Blue Shield | $77 - $331 | 34% |
| Kindful Hospice [20434] | $77 | 34% |
| Medicare (plans) | $77 - $190 | 34% |
| Pace Of The Ozarks Contracted [320518] | $77 | 34% |
| Provider Partners Health Plans Contracted [320450] | $77 | 34% |
| Elara Caring Aspire Hospice [20433] | $77 | 34% |
| Qual Choice Contracted [320325] | $77 | 34% |
| Aetna | $77 - $95 | 34% |
| Cross Timbers Hospice [20098] | $77 | 34% |
| Home State Health Plan Contracted [320187] | $77 | 34% |
| Mercy Hospice Okc [20252] | $77 | 34% |
| Kindful Hospice Contracted [320434] | $77 | 34% |
| Cigna | $77 | 34% |
| Ambetter / Centene | $77 | 34% |
| Cherokee Nation Health Serv Contracted [320066] | $77 | 34% |
| Dept Of Veteran Affairs Contracted [320106] | $77 | 34% |
| Healthscope Contracted [320182] | $82 | 37% |
| Workers Comp [20426] | $85 - $90 | 38% |
| United Medical Resources Contracted [320454] | $88 - $101 | 39% |
| Preferred Health Plan Contracted [320522] | $95 | 42% |
| Usa Managed Care Org Contracted [320429] | $95 | 42% |
| Federal Medical Center Contracted [320127] | $95 | 42% |
| Healthlink Contracted [320179] | $95 - $101 | 42% |
| Medica Contracted [320239] | $95 | 42% |
| Mercy Benefit Admin Contracted [320251] | $95 - $101 | 42% |
| American Healthcare Alliance Contracted [320020] | $95 | 42% |
| First Health Contracted [320128] | $95 | 42% |
| Benefit Management Contracted [320052] | $101 | 45% |
| Private Health Care Systems Contracted [320320] | $101 | 45% |
| Edison Health Solutions Contracted [320502] | $101 | 45% |
| Ebms Contracted [320493] | $101 | 45% |
| Ppo Plus Contracted [320310] | $101 | 45% |
| Point C Contracted [320238] | $101 | 45% |
| Yuzu Health Contracted [320521] | $101 | 45% |
| Imagine 360 Contracted [320494] | $101 | 45% |
| Auxiant Contracted [320462] | $101 | 45% |
| Show-Me Health Administrators Contracted [320483] | $101 | 45% |
| Aither Health Contracted [320449] | $101 | 45% |
| 90 Degree Benefits Contracted [320436] | $101 | 45% |
| Reflect Health Contracted [320492] | $101 | 45% |
Consumer Guidance & Cost Commentary
For this breathing treatment (nebulizer) service at Mercy Hospital Columbus, the facility's cash price of $69.00 is significantly lower than the state average of $106.00 and the Medicare benchmark of $223.72. While many commercial payers negotiate rates between $77.00 and $101.00, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans or those who have met their out-of-pocket limits may save money by paying cash directly. It is important to note that while the facility is a Critical Access Hospital in a Voluntary non-profit - Church ownership structure, the negotiated rates for in-network plans do not always represent the lowest possible cost, as administrative overhead and contract dynamics can inflate the baseline price by 20% to 40% compared to direct payment.
Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the costly insurance billing cycle and administrative labor that inflates commercial rates. Although the data shows a median negotiated rate of $95.00, which is higher than the cash price, the No Surprises Act provides federal protections against balance billing for out-of-network providers at in-network facilities, ensuring that unexpected charges for emergency or non-emergency services are not passed to the patient. To ensure you are receiving the most accurate pricing, always request a full itemized CPT-coded bill rather than a summary invoice, and verify your deductible status before using insurance to avoid paying higher negotiated rates when you have not yet met your plan's coverage threshold.