CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Louis Childrens Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $197
Cash Discount Price: $158
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Louis Childrens Hospital is $197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $158. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.88x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$158

Average discount available for prompt cash payment at this facility.

Insurance Median

$197

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: $158 (71%)

Insurance Median: $197 (88%)

Cash: $158 (71% of Medicare)

Ins. Median: $197 (88% 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
Healthlink [225]	$128 - $199	57%
Cigna	$130 - $143	58%
Apwu Health Plan [216]	$143	64%
Consociate [478]	$143	64%
Nalc Health Benefit Plan [242]	$143	64%
Priority Health [648]	$143	64%
Sarah Bush Lincoln [636]	$143	64%
Blue Cross Blue Shield	$145 - $224	65%
Cox Health Systems Insurance Company [220]	$145 - $195	65%
Allied Benefits [498]	$153 - $209	68%
Hope Trust [806]	$153	68%
Med-Pay [480]	$172 - $198	77%
Unicare [568]	$172 - $199	77%
Health Alliance [224]	$185	83%
Healthscope Benefits [258]	$188 - $211	84%
UnitedHealthcare	$188 - $216	84%
Aetna	$196 - $216	88%
First Health Commercial [734]	$196	88%
Humana	$197 - $216	88%
Beechstreet [551]	$198	89%
Detego Health [868]	$198	89%
Health Systems Inc [620]	$198	89%
Healthcare Sol Mercy [609]	$198	89%
Multiplan Commercial [737]	$198	89%
Multiplan [240]	$198	89%
Phcs [244]	$198 - $211	89%
Preferred Health Professionals [561]	$199	89%
Coresource [497]	$209	93%
Fmh Benefit Service Inc [222]	$209	93%
Mail Handlers [495]	$209	93%
Medica [661]	$211	94%
Essence Healthcare [221]	$216	97%
Hfn [563]	$224	100%
Cox Health [757]	$226	101%
Medica [662]	$226	101%

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 $158.
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 St Louis Childrens 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.