CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy Hospital Aurora
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $176
- Cash Discount Price: $137
- vs. Medicare Baseline: 0.79x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital Aurora is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.79x the Medicare baseline. Located in 500 Porter Avenue, Aurora, MO.
Cash / Self-Pay
$137
Average discount available for prompt cash payment at this facility.
Insurance Median
$176
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: $137 (61%)
Insurance Median: $176 (79%)
Cash: $137 (61% of Medicare)
Ins. Median: $176 (79% 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
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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 - $252 | 3% |
| Aetna | $59 - $192 | 26% |
| Blue Cross Blue Shield | $59 - $267 | 26% |
| Cherokee Nation Health Serv Contracted [320066] | $59 - $61 | 26% |
| Cigna | $59 - $184 | 26% |
| Cross Timbers Hospice [20098] | $59 - $61 | 26% |
| Elara Caring Aspire Hospice [20433] | $59 - $61 | 26% |
| Globalhealth Contracted [320145] | $59 - $61 | 26% |
| Halo Hcr Inc Hospice Contracted [320432] | $59 - $61 | 26% |
| Halo Hcr Inc Hospice [20432] | $59 - $61 | 26% |
| Humana | $59 - $184 | 26% |
| Indian Health Service Contracted [320198] | $59 - $61 | 26% |
| Kindful Hospice Contracted [320434] | $59 - $61 | 26% |
| Kindful Hospice [20434] | $59 - $61 | 26% |
| Medical Associates Health Contracted [320444] | $59 - $61 | 26% |
| Medicare (plans) | $59 - $190 | 26% |
| Mercy Hospice Okc [20252] | $59 - $61 | 26% |
| Mercy Mgd Behavioral Health Contracted [320259] | $59 - $61 | 26% |
| Pace Of The Ozarks Contracted [320518] | $59 - $61 | 26% |
| Provider Partners Health Plans Contracted [320450] | $59 - $61 | 26% |
| Qual Choice Contracted [320325] | $59 - $61 | 26% |
| UnitedHealthcare | $59 - $267 | 26% |
| Dept Of Veteran Affairs Contracted [320106] | $60 - $63 | 27% |
| Tricare | $60 - $63 | 27% |
| Healthscope Contracted [320182] | $76 - $80 | 34% |
| Centivo Contracted [320505] | $83 - $86 | 37% |
| Administrative Payor Contracted [320005] | $93 - $97 | 42% |
| Ambetter / Centene | $105 - $110 | 47% |
| Home State Health Plan Contracted [320187] | $105 - $110 | 47% |
| Novasys Contracted [320285] | $105 - $110 | 47% |
| Healthlink Contracted [320179] | $135 - $194 | 60% |
| Preferred Health Plan Contracted [320522] | $135 - $140 | 60% |
| Health Systems Inc Contracted [320174] | $166 - $173 | 74% |
| Insurance System Inc Contracted [320465] | $166 - $173 | 74% |
| Point C Contracted [320238] | $166 - $184 | 74% |
| Point C [20238] | $166 - $173 | 74% |
| Workers Comp [20426] | $166 - $184 | 74% |
| Medica Contracted [320239] | $175 - $183 | 78% |
| 90 Degree Benefits Contracted [320436] | $176 - $184 | 79% |
| Aither Health Contracted [320449] | $176 - $184 | 79% |
| American Healthcare Alliance Contracted [320020] | $176 - $184 | 79% |
| Auxiant Contracted [320462] | $176 - $184 | 79% |
| Benefit Management Contracted [320052] | $176 - $184 | 79% |
| Ebms Contracted [320493] | $176 - $184 | 79% |
| Edison Health Solutions Contracted [320502] | $176 - $184 | 79% |
| Evolutions Health Care Contracted [320124] | $176 - $184 | 79% |
| First Health Contracted [320128] | $176 - $184 | 79% |
| Imagine 360 Contracted [320494] | $176 - $184 | 79% |
| Mercy Benefit Admin Contracted [320251] | $176 - $184 | 79% |
| Reflect Health Contracted [320492] | $176 - $184 | 79% |
| Show-Me Health Administrators Contracted [320483] | $176 - $184 | 79% |
| United Medical Resources Contracted [320454] | $176 - $190 | 79% |
| Yuzu Health Contracted [320521] | $176 - $184 | 79% |
| Usa Managed Care Org Contracted [320429] | $182 - $190 | 81% |
| Multiplan Contracted [320270] | $197 - $205 | 88% |
| Private Health Care Systems Contracted [320320] | $197 - $205 | 88% |