CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Mercy St Francis Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $190
- Cash Discount Price: $135
- vs. Medicare Baseline: 0.85x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercy St Francis Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.85x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.
Cash / Self-Pay
$135
Average discount available for prompt cash payment at this facility.
Insurance Median
$190
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: $135 (60%)
Insurance Median: $190 (85%)
Cash: $135 (60% of Medicare)
Ins. Median: $190 (85% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Mercy Hospice Okc [20252] | $57 - $71 | 25% |
| Blue Cross Blue Shield | $57 - $249 | 25% |
| Pace of the Ozarks Contracted [320518] | $57 - $71 | 25% |
| Halo Hcr Inc Hospice Contracted [320432] | $57 - $71 | 25% |
| Mercy Mgd Behavioral Health Contracted [320259] | $57 - $71 | 25% |
| Elara Caring Aspire Hospice [20433] | $57 - $71 | 25% |
| Dept of Veteran Affairs Contracted [320106] | $57 - $71 | 25% |
| Cherokee Nation Health Serv Contracted [320066] | $57 - $71 | 25% |
| Humana | $57 - $186 | 25% |
| Globalhealth Contracted [320145] | $57 - $71 | 25% |
| Medical Associates Health Contracted [320444] | $57 - $71 | 25% |
| Kindful Hospice [20434] | $57 - $71 | 25% |
| Qual Choice Contracted [320325] | $57 - $71 | 25% |
| Kindful Hospice Contracted [320434] | $57 - $71 | 25% |
| Provider Partners Health Plans Contracted [320450] | $57 - $71 | 25% |
| Indian Health Service Contracted [320198] | $57 - $71 | 25% |
| Medicare (plans) | $57 - $226 | 25% |
| Cross Timbers Hospice [20098] | $57 - $71 | 25% |
| Cigna | $57 - $197 | 25% |
| Aetna | $57 - $184 | 25% |
| Acentra Health Contracted [320527] | $57 | 25% |
| UnitedHealthcare | $57 - $267 | 25% |
| Halo Hcr Inc Hospice [20432] | $57 - $71 | 25% |
| Medicaid / KanCare | $69 - $267 | 31% |
| Tricare | $70 | 31% |
| Healthscope Contracted [320182] | $71 - $94 | 32% |
| Administrative Payor Contracted [320005] | $93 | 42% |
| Centivo Contracted [320505] | $94 - $120 | 42% |
| Ambetter / Centene | $107 | 48% |
| Novasys Contracted [320285] | $107 | 48% |
| Home State Health Plan Contracted [320187] | $107 | 48% |
| Preferred Health Plan Contracted [320522] | $135 | 60% |
| Healthlink Contracted [320179] | $135 - $197 | 60% |
| Workers Comp [20426] | $166 - $176 | 74% |
| Auxiant Contracted [320462] | $186 - $197 | 83% |
| United Medical Resources Contracted [320454] | $186 - $193 | 83% |
| Point C Contracted [320238] | $186 - $197 | 83% |
| Mercy Benefit Admin Contracted [320251] | $186 - $197 | 83% |
| Medica Contracted [320239] | $196 | 88% |
| Aither Health Contracted [320449] | $197 | 88% |
| Point C [20238] | $197 | 88% |
| Show-Me Health Administrators Contracted [320483] | $197 | 88% |
| Multiplan Contracted [320270] | $197 | 88% |
| Imagine 360 Contracted [320494] | $197 | 88% |
| Yuzu Health Contracted [320521] | $197 | 88% |
| Ebms Contracted [320493] | $197 | 88% |
| Evolutions Health Care Contracted [320124] | $197 | 88% |
| Edison Health Solutions Contracted [320502] | $197 | 88% |
| USA Managed Care Org Contracted [320429] | $197 | 88% |
| Reflect Health Contracted [320492] | $197 | 88% |
| Private Health Care Systems Contracted [320320] | $197 | 88% |
| Benefit Management Contracted [320052] | $197 | 88% |
| 90 Degree Benefits Contracted [320436] | $197 | 88% |
| Health Systems Inc Contracted [320174] | $197 | 88% |
| Insurance System Inc Contracted [320465] | $197 | 88% |
| First Health Contracted [320128] | $197 | 88% |