CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy Hospital St Louis
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $185
- Cash Discount Price: $270
- vs. Medicare Baseline: 0.83x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital St Louis is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $270. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.83x the Medicare baseline. Located in 615 New Ballas Road, Saint Louis, MO.
Cash / Self-Pay
$270
Average discount available for prompt cash payment at this facility.
Insurance Median
$185
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: $270 (121%)
Insurance Median: $185 (83%)
Cash: $270 (121% of Medicare)
Ins. Median: $185 (83% 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 |
|---|---|---|
| Aetna | $26 - $189 | 12% |
| Medicaid / KanCare | $26 - $270 | 12% |
| Cigna | $56 - $194 | 25% |
| Blue Cross Blue Shield | $62 - $388 | 28% |
| UnitedHealthcare | $87 - $225 | 39% |
| Medica Contracted [320239] | $104 - $112 | 46% |
| United Medical Resources Contracted [320454] | $107 - $118 | 48% |
| Ambetter / Centene | $108 - $116 | 48% |
| Home State Health Plan Contracted [320187] | $108 - $116 | 48% |
| Novasys Contracted [320285] | $108 - $116 | 48% |
| Aither Health Contracted [320449] | $172 - $185 | 77% |
| Aither Health [20449] | $172 - $185 | 77% |
| Auxiant Contracted [320462] | $172 - $185 | 77% |
| Ebms Contracted [320493] | $172 - $185 | 77% |
| Edison Health Solutions Contracted [320502] | $172 - $185 | 77% |
| Healthlink Contracted [320179] | $172 - $293 | 77% |
| Imagine 360 Contracted [320494] | $172 - $185 | 77% |
| Mercy Benefit Admin Contracted [320251] | $172 - $194 | 77% |
| Mercy Benefit Admin [20251] | $172 - $194 | 77% |
| Reflect Health Contracted [320492] | $172 - $185 | 77% |
| Show-Me Health Administrators Contracted [320483] | $172 - $185 | 77% |
| Yuzu Health Contracted [320521] | $172 - $185 | 77% |
| American Health Advantage Of Mo Mcr [10473] | $189 | 84% |
| Cherokee Nation Health Serv Contracted [320066] | $189 | 84% |
| Cross Timbers Hospice [20098] | $189 | 84% |
| Dept Of Veteran Affairs Contracted [320106] | $189 | 84% |
| Elara Caring Aspire Hospice Contracted [320433] | $189 | 84% |
| Elara Caring Aspire Hospice [20433] | $189 | 84% |
| Globalhealth Contracted [320145] | $189 | 84% |
| Halo Hcr Inc Hospice Contracted [320432] | $189 | 84% |
| Halo Hcr Inc Hospice [20432] | $189 | 84% |
| Humana | $189 | 84% |
| Kindful Hospice Contracted [320434] | $189 | 84% |
| Kindful Hospice [20434] | $189 | 84% |
| Medicare (plans) | $189 - $431 | 84% |
| Mercy Hospice Okc [20252] | $189 | 84% |
| Pace Of The Ozarks Contracted [320518] | $189 | 84% |
| Qual Choice Contracted [320325] | $189 | 84% |
| Tricare | $189 | 84% |
| Hope Trust Contracted [320488] | $193 | 86% |
| Provider Partners Health Plans Contracted [320450] | $208 | 93% |
| Health Choices Contracted [320448] | $240 - $259 | 107% |
| Health Choices [20448] | $240 - $259 | 107% |
| Medical Associates Health Contracted [320444] | $240 - $259 | 107% |
| Healthscope Contracted [320182] | $241 | 108% |
| Federal Medical Center Contracted [320127] | $260 - $280 | 116% |
| Insurance System Inc Contracted [320465] | $260 - $280 | 116% |
| Point C Contracted [320238] | $260 - $280 | 116% |
| Tri State Healthcare Coalition Contracted [320379] | $260 - $280 | 116% |
| First Health Contracted [320128] | $280 - $306 | 125% |
| Mercy Mgd Behavioral Health Contracted [320259] | $280 - $302 | 125% |
| Multiplan Contracted [320270] | $280 - $323 | 125% |
| Private Health Care Systems Contracted [320320] | $280 - $302 | 125% |
| Workers Comp [20426] | $300 - $345 | 134% |
| Centivo Contracted [320505] | $318 | 142% |
| Preferred Health Plan Contracted [320522] | $337 | 151% |