CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy Hospital Lincoln
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $161
- Cash Discount Price: $140
- vs. Medicare Baseline: 0.72x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital Lincoln is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.72x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.
Cash / Self-Pay
$140
Average discount available for prompt cash payment at this facility.
Insurance Median
$161
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: $140 (63%)
Insurance Median: $161 (72%)
Cash: $140 (63% of Medicare)
Ins. Median: $161 (72% 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 | $14 - $267 | 6% |
| Aetna | $32 - $141 | 14% |
| Medicare (plans) | $46 - $215 | 21% |
| Tricare | $46 | 21% |
| UnitedHealthcare | $47 - $256 | 21% |
| Provider Partners Health Plans Contracted [320450] | $50 | 22% |
| American Health Advantage Of Mo Mcr [10473] | $51 | 23% |
| Blue Cross Blue Shield | $51 - $267 | 23% |
| Cherokee Nation Health Serv Contracted [320066] | $51 | 23% |
| Cross Timbers Hospice [20098] | $51 | 23% |
| Dept Of Veteran Affairs Contracted [320106] | $51 | 23% |
| Elara Caring Aspire Hospice Contracted [320433] | $51 | 23% |
| Elara Caring Aspire Hospice [20433] | $51 | 23% |
| Globalhealth Contracted [320145] | $51 | 23% |
| Halo Hcr Inc Hospice Contracted [320432] | $51 | 23% |
| Halo Hcr Inc Hospice [20432] | $51 | 23% |
| Humana | $51 - $194 | 23% |
| Indian Health Service Contracted [320198] | $51 | 23% |
| Kindful Hospice Contracted [320434] | $51 | 23% |
| Kindful Hospice [20434] | $51 | 23% |
| Mercy Hospice Okc [20252] | $51 | 23% |
| Pace Of The Ozarks Contracted [320518] | $51 | 23% |
| Qual Choice Contracted [320325] | $51 | 23% |
| Cigna | $54 - $56 | 24% |
| Centivo Contracted [320505] | $78 | 35% |
| Medica Contracted [320239] | $90 | 40% |
| Ambetter / Centene | $99 | 44% |
| Home State Health Plan Contracted [320187] | $99 | 44% |
| Novasys Contracted [320285] | $99 | 44% |
| Hope Trust Contracted [320488] | $106 | 47% |
| Health Choices Contracted [320448] | $129 | 58% |
| Health Choices [20448] | $129 | 58% |
| Medical Associates Health Contracted [320444] | $129 | 58% |
| First Health Contracted [320128] | $141 - $161 | 63% |
| United Medical Resources Contracted [320454] | $142 | 63% |
| Mercy Mgd Behavioral Health Contracted [320259] | $161 | 72% |
| Multiplan Contracted [320270] | $161 | 72% |
| Private Health Care Systems Contracted [320320] | $161 | 72% |
| Workers Comp [20426] | $161 - $172 | 72% |
| Healthlink Contracted [320179] | $174 - $191 | 78% |
| Aither Health Contracted [320449] | $183 | 82% |
| Aither Health [20449] | $183 | 82% |
| Auxiant Contracted [320462] | $183 | 82% |
| Ebms Contracted [320493] | $183 | 82% |
| Edison Health Solutions Contracted [320502] | $183 | 82% |
| Federal Medical Center Contracted [320127] | $183 | 82% |
| Imagine 360 Contracted [320494] | $183 | 82% |
| Insurance System Inc Contracted [320465] | $183 | 82% |
| Mercy Benefit Admin Contracted [320251] | $183 | 82% |
| Mercy Benefit Admin [20251] | $183 | 82% |
| Point C Contracted [320238] | $183 | 82% |
| Preferred Health Plan Contracted [320522] | $183 | 82% |
| Reflect Health Contracted [320492] | $183 | 82% |
| Show-Me Health Administrators Contracted [320483] | $183 | 82% |
| Tri State Healthcare Coalition Contracted [320379] | $183 | 82% |
| Yuzu Health Contracted [320521] | $183 | 82% |