CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mercy Hospital Southeast

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $191
Cash Discount Price: $162
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital Southeast is $191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.85x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$191

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: $162 (72%)

Insurance Median: $191 (85%)

Cash: $162 (72% of Medicare)

Ins. Median: $191 (85% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$12 - $221	5%
Medicaid / KanCare	$12 - $312	5%
Blue Cross Blue Shield	$86 - $1,128	38%
First Health Contracted [320128]	$116 - $221	52%
Health Alliance Contracted [320164]	$118 - $224	53%
Aither Health Contracted [320449]	$124 - $235	55%
Edison Health Solutions Contracted [320502]	$124 - $235	55%
Healthlink Contracted [320179]	$124 - $430	55%
Mercy Benefit Admin Contracted [320251]	$124 - $321	55%
Mercy Benefit Admin [20251]	$124 - $235	55%
Yuzu Health Contracted [320521]	$124 - $235	55%
Imagine 360 Contracted [320494]	$128	57%
Workers Comp [20426]	$136 - $276	61%
Multiplan Contracted [320270]	$146 - $276	65%
Private Health Care Systems Contracted [320320]	$146 - $276	65%
Humana	$155 - $293	69%
Cross Timbers Hospice [20098]	$191	85%
Dept Of Veteran Affairs Contracted [320106]	$191	85%
Elara Caring Aspire Hospice Contracted [320433]	$191	85%
Elara Caring Aspire Hospice [20433]	$191	85%
Halo Hcr Inc Hospice Contracted [320432]	$191	85%
Halo Hcr Inc Hospice [20432]	$191	85%
Kindful Hospice Contracted [320434]	$191	85%
Kindful Hospice [20434]	$191	85%
Medicare (plans)	$191 - $201	85%
Mercy Hospice Okc [20252]	$191	85%
Pace Of The Ozarks Contracted [320518]	$191	85%
Tricare	$191	85%
Ambetter / Centene	$195	87%
American Health Advantage Of Mo Mcr Hmo Contracted [320264]	$195	87%
Home State Health Plan Contracted [320187]	$195	87%
Hope Trust Contracted [320488]	$195	87%
UnitedHealthcare	$195 - $1,312	87%
Provider Partners Health Plans Contracted [320450]	$220	98%
Cigna	$242 - $446	108%
Consociate Consolidated Health Contracted [320490]	$267 - $430	119%
Auxiant Contracted [320462]	$321 - $382	143%
Centivo Contracted [320505]	$321	143%
Ebms Contracted [320493]	$321	143%
Reflect Health Contracted [320492]	$333	149%
Preferred Health Plan Contracted [320522]	$341	152%
United Medical Resources Contracted [320454]	$1,312	586%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $162.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 94640.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Southeast is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 94640.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.