CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: The Children's Mercy Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $119
Cash Discount Price: $87
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at The Children's Mercy Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.53x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $87 (39%)

Insurance Median: $119 (53%)

Cash: $87 (39% of Medicare)

Ins. Median: $119 (53% 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
UnitedHealthcare	$73 - $530	33%
Blue Cross Blue Shield	$74 - $134	33%
Healthy Blue	$77 - $530	34%
Medicaid / KanCare	$81	36%
Cigna	$87 - $126	39%
Medica	$106	47%
Aetna	$109 - $123	49%
Centivo	$118	53%
Health Midwest Comprehensive Care	$118	53%
Nebraska Furniture Mart	$118	53%
Orscheln	$118	53%
Quiktrip	$118	53%
Wellfit/Centrus	$118	53%
Wppa Providrs Care	$118	53%
Humana	$120	54%
Coventry Health Care Of Kansas	$134	60%
Coxhealth Network	$134	60%
Mercy Health	$136	61%
Multiplan	$138	62%
American Healthcare Alliance	$154	69%
Healthlink	$159	71%
National Preferred Provider Network	$163	73%
Home State Health	$465	208%

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 $87.
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 The Children's Mercy 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.