CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Missouri Baptist Sullivan Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $299
Cash Discount Price: $275
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Missouri Baptist Sullivan Hospital is $299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $275. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.34x the Medicare baseline. Located in 751 Sappington Bridge Rd, Sullivan, MO.

Cash / Self-Pay

$275

Average discount available for prompt cash payment at this facility.

Insurance Median

$299

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: $275 (123%)

Insurance Median: $299 (134%)

Cash: $275 (123% of Medicare)

Ins. Median: $299 (134% 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	$101 - $344	45%
Essence Healthcare [221]	$101	45%
Humana	$102 - $305	46%
UnitedHealthcare	$103 - $340	46%
Cox Health [757]	$106	47%
Blue Cross Blue Shield	$107 - $398	48%
Medica [662]	$108	48%
Devoted Health Plan [847]	$111	50%
Healthlink [225]	$222 - $346	99%
Consociate [478]	$247	110%
Sarah Bush Lincoln [636]	$247	110%
Cox Health Systems Insurance Company [220]	$252 - $298	113%
Health Alliance [224]	$252	113%
Allied Benefits [498]	$266 - $340	119%
Hope Trust [806]	$266	119%
Coresource [497]	$276	123%
Fmh Benefit Service Inc [222]	$276	123%
Mail Handlers [495]	$276	123%
Cigna	$279 - $366	125%
Healthscope Benefits [258]	$298 - $310	133%
Med-Pay [480]	$298 - $344	133%
Unicare [568]	$298 - $346	133%
Apwu Health Plan [216]	$315	141%
Nalc Health Benefit Plan [242]	$315	141%
Priority Health [648]	$315	141%
First Health Commercial [734]	$340	152%
Beechstreet [551]	$344	154%
Detego Health [868]	$344	154%
Health Systems Inc [620]	$344	154%
Healthcare Sol Mercy [609]	$344	154%
Multiplan Commercial [737]	$344	154%
Multiplan [240]	$344	154%
Phcs [244]	$344 - $366	154%
Preferred Health Professionals [561]	$346	155%
Hfn [563]	$366	164%
Medica [661]	$366	164%

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 $275.
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 Missouri Baptist Sullivan Hospital 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.