CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy Hospital Springfield
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $181
- Cash Discount Price: $212
- vs. Medicare Baseline: 0.81x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital Springfield is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $212. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.81x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$212
Average discount available for prompt cash payment at this facility.
Insurance Median
$181
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: $212 (95%)
Insurance Median: $181 (81%)
Cash: $212 (95% of Medicare)
Ins. Median: $181 (81% 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 |
|---|---|---|
| Medicaid / KanCare | $6 - $260 | 3% |
| Aetna | $7 - $2,519 | 3% |
| Blue Cross Blue Shield | $7 - $2,002 | 3% |
| Humana | $7 - $226 | 3% |
| Medica Contracted [320239] | $88 - $132 | 39% |
| Medica [20239] | $88 - $132 | 39% |
| Benefit Management Contracted [320052] | $89 - $133 | 40% |
| Health Systems Inc Contracted [320174] | $89 - $133 | 40% |
| Insurance System Inc Contracted [320465] | $89 - $133 | 40% |
| Ambetter / Centene | $90 - $136 | 40% |
| Home State Health Plan Contracted [320187] | $90 - $136 | 40% |
| Novasys Contracted [320285] | $90 - $136 | 40% |
| Administrative Payor Contracted [320005] | $100 - $166 | 45% |
| Evolutions Health Care Contracted [320124] | $100 - $150 | 45% |
| Point C Contracted [320238] | $100 - $2,100 | 45% |
| Point C [20238] | $100 - $2,035 | 45% |
| Medical Destinations Contracted [320242] | $111 - $166 | 50% |
| Mercy Benefit Admin Contracted [320251] | $111 - $1,957 | 50% |
| Workers Comp [20426] | $111 - $283 | 50% |
| United Medical Resources Contracted [320454] | $115 - $2,475 | 51% |
| First Health Contracted [320128] | $124 - $186 | 55% |
| Aither Health Contracted [320449] | $127 - $190 | 57% |
| Auxiant Contracted [320462] | $127 - $216 | 57% |
| Ebms Contracted [320493] | $127 - $190 | 57% |
| Edison Health Solutions Contracted [320502] | $127 - $190 | 57% |
| Healthlink Contracted [320179] | $127 - $266 | 57% |
| Imagine 360 Contracted [320494] | $127 - $190 | 57% |
| Reflect Health Contracted [320492] | $127 - $190 | 57% |
| Yuzu Health Contracted [320521] | $127 - $190 | 57% |
| 90 Degree Benefits Contracted [320436] | $133 - $200 | 59% |
| Federal Medical Center Contracted [320127] | $133 - $2,600 | 59% |
| Show-Me Health Administrators Contracted [320483] | $133 - $200 | 59% |
| Cigna | $153 - $256 | 68% |
| Multiplan Contracted [320270] | $171 - $256 | 76% |
| Private Health Care Systems Contracted [320320] | $171 - $256 | 76% |
| UnitedHealthcare | $171 - $4,067 | 76% |
| Compcare Of The Ozarks Contracted [320437] | $175 - $263 | 78% |
| American Healthcare Alliance Contracted [320020] | $178 - $266 | 80% |
| Qual Choice Contracted [320324] | $178 - $266 | 80% |
| Municipal Health Plan Contracted [320271] | $180 - $270 | 80% |
| Centurion Of Missouri [20459] | $181 | 81% |
| Champva [20065] | $181 | 81% |
| Cherokee Nation Health Serv Contracted [320066] | $181 | 81% |
| Cross Timbers Hospice [20098] | $181 | 81% |
| Dept Of Veteran Affairs Contracted [320106] | $181 | 81% |
| Elara Caring Aspire Hospice [20433] | $181 | 81% |
| Globalhealth Contracted [320145] | $181 | 81% |
| Halo Hcr Inc Hospice Contracted [320432] | $181 | 81% |
| Halo Hcr Inc Hospice [20432] | $181 | 81% |
| Indian Health Service Contracted [320198] | $181 | 81% |
| Indian Health Service [20198] | $181 | 81% |
| Kindful Hospice Contracted [320434] | $181 | 81% |
| Kindful Hospice [20434] | $181 | 81% |
| Medicare (plans) | $181 - $190 | 81% |
| Mercy Hospice Okc [20252] | $181 | 81% |
| Mercy Mgd Behavioral Health Contracted [320259] | $181 | 81% |
| Mercy Rehab Hospital Contracted [320260] | $181 | 81% |
| Pace Of The Ozarks Contracted [320518] | $181 | 81% |
| Qual Choice Contracted [320325] | $181 | 81% |
| Tricare | $181 | 81% |
| Usa Managed Care Org Contracted [320429] | $195 - $293 | 87% |
| Provider Partners Health Plans Contracted [320450] | $199 | 89% |
| Ppo Plus Contracted [320310] | $200 - $300 | 89% |
| Healthscope Contracted [320182] | $230 | 103% |
| Centivo Contracted [320505] | $304 | 136% |
| Providrs Care Network Contracted [320484] | $376 | 168% |