CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy Hospital Ada
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $122
- Cash Discount Price: $113
- vs. Medicare Baseline: 0.55x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy Hospital Ada is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.55x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.
Cash / Self-Pay
$113
Average discount available for prompt cash payment at this facility.
Insurance Median
$122
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: $113 (51%)
Insurance Median: $122 (55%)
Cash: $113 (51% of Medicare)
Ins. Median: $122 (55% 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 |
|---|---|---|
| Aetna | $7 - $203 | 3% |
| Humana | $7 - $207 | 3% |
| Medicaid / KanCare | $7 - $280 | 3% |
| Healthcare Highways Plus Contracted [320175] | $68 - $130 | 30% |
| Webtpa Contracted [320417] | $73 | 33% |
| Osma Health Contracted [320292] | $78 | 35% |
| UnitedHealthcare | $80 - $203 | 36% |
| Medica Contracted [320239] | $81 - $174 | 36% |
| Benefit Management Contracted [320052] | $87 - $113 | 39% |
| Aither Health Contracted [320449] | $104 | 46% |
| Auxiant Contracted [320462] | $104 | 46% |
| Ebms Contracted [320493] | $104 | 46% |
| Federal Medical Center Contracted [320127] | $104 | 46% |
| Healthlink Contracted [320179] | $104 | 46% |
| Healthscope Contracted [320182] | $104 | 46% |
| Imagine 360 Contracted [320494] | $104 | 46% |
| Mercy Benefit Admin Contracted [320251] | $104 - $113 | 46% |
| Point C Contracted [320238] | $104 | 46% |
| Preferred Health Plan Contracted [320522] | $104 | 46% |
| Quik Trip Contracted [320447] | $104 | 46% |
| Reflect Health Contracted [320492] | $104 | 46% |
| Show-Me Health Administrators Contracted [320483] | $104 | 46% |
| United Medical Resources Contracted [320454] | $104 - $122 | 46% |
| Workers Comp [20426] | $104 | 46% |
| Yuzu Health Contracted [320521] | $104 | 46% |
| Globalhealth Contracted [320144] | $110 | 49% |
| First Health Contracted [320128] | $145 | 65% |
| Multiplan Contracted [320270] | $148 | 66% |
| Private Health Care Systems Contracted [320320] | $148 | 66% |
| Medicare (plans) | $174 - $207 | 78% |
| Blue Cross Blue Shield | $203 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $203 | 91% |
| Cross Timbers Hospice [20098] | $203 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $203 | 91% |
| Elara Caring Aspire Hospice Contracted [320433] | $203 | 91% |
| Elara Caring Aspire Hospice [20433] | $203 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $203 | 91% |
| Halo Hcr Inc Hospice [20432] | $203 | 91% |
| Independent Health [20197] | $203 | 91% |
| Indian Health Service Contracted [320198] | $203 | 91% |
| Kindful Hospice Contracted [320434] | $203 | 91% |
| Kindful Hospice [20434] | $203 | 91% |
| Medical Associates Health [20444] | $203 | 91% |
| Mercy Hospice Okc [20252] | $203 | 91% |
| Provider Partners Health Plans Contracted [320450] | $203 | 91% |
| Qual Choice Contracted [320325] | $203 | 91% |
| Tricare | $203 | 91% |
| Globalhealth Contracted [320145] | $207 | 93% |
| Cigna | $209 | 93% |
| Ambetter / Centene | $280 | 125% |
| Home State Health Plan Contracted [320187] | $280 | 125% |
| Novasys Contracted [320285] | $280 | 125% |
| Health Choice Contracted [320166] | $407 | 182% |
| Healthsmart Preferred Care Contracted [320184] | $457 | 204% |
| Kempton Contracted [320214] | $457 | 204% |