CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mercy Rehabilitation Hospital South

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $642
Cash Discount Price: $642
vs. Medicare Baseline: 2.87x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Rehabilitation Hospital South is $642. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $642. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 2.87x the Medicare baseline. Located in 10114 Kennerly Rd, Saint Louis, MO.

Cash / Self-Pay

$642

Average discount available for prompt cash payment at this facility.

Insurance Median

$642

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: $642 (287%)

Insurance Median: $642 (287%)

Cash: $642 (287% of Medicare)

Ins. Median: $642 (287% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 287% of the Medicare baseline (a markup of 187%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$642	287%
Ambetter / Centene	$642	287%
Blue Cross Blue Shield	$642	287%
Cigna	$642	287%
Devoted Health	$642	287%
Essence	$642	287%
Healthlink Hmo	$642	287%
Healthlink Ppo	$642	287%
Healthy Blue (Missouri Care)	$642	287%
Homestate Health Plan	$642	287%
Humana	$642	287%
Medica	$642	287%
Medicaid / KanCare	$642	287%
Meritain Health Cpd	$642	287%
Meritain Health Ppo Cpd	$642	287%
Starmark Cpd	$642	287%
Tricare	$642	287%
UnitedHealthcare	$642	287%
Wellcare	$642	287%

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 $642.
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 Rehabilitation Hospital South 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.