CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mercyone Newton Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $285
  • Cash Discount Price: $16,453
  • vs. Medicare Baseline: 1.27x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercyone Newton Medical Center is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,453. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.27x the Medicare baseline. Located in 204 N 4Th Ave E, Newton, IA.
Cash / Self-Pay
$16,453

Average discount available for prompt cash payment at this facility.

Insurance Median
$285

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: $16,453 (7354%)
Insurance Median: $285 (127%)
Cash: $16,453 (7354% of Medicare)
Ins. Median: $285 (127% 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
Iowa Dept Of Public Health $9 - $304 4%
Newton Correctional Facility $198 89%
Aetna $207 - $12,153 93%
Medicare (plans) $207 - $12,649 93%
Blue Cross Blue Shield $209 - $13,117 93%
UnitedHealthcare $211 - $12,396 94%
Geha $219 98%
Blue Benefit Administrators Of Massachusetts $224 - $13,117 100%
Blue Care Network $224 - $13,117 100%
Blue Distinction Transplant $224 - $13,117 100%
Blue Shield - Ca $224 - $13,117 100%
Blue Shield - Id (Regence) $224 - $13,117 100%
Blue Shield - Ny Highmark Northeastern $224 - $13,117 100%
Blue Shield - Ny Highmark Western $224 - $13,117 100%
Blue Shield - Pa (Highmark) $224 - $13,117 100%
Blue Shield - Wa (Regence) $224 - $13,117 100%
Health Choices $230 103%
Medical Associates $230 103%
Iowa Total Care $253 - $14,807 113%
Medicaid / KanCare $255 - $15,010 114%
Health Partners $268 120%
Auxiant $280 125%
Cigna $280 125%
Health Alliance $280 125%
Medica $280 125%
Midlands $280 125%
Midlands Choice $280 125%
Amish Hospital Aid $281 - $16,493 126%
1199 National Benefit Fund $285 127%
Allied Benefit Systems $285 127%
Asr Health Benefits $285 127%
Christian Brother Services $285 127%
Coventry $285 127%
First Health $285 127%
Lucent Health $285 127%
Luminare Health $285 127%
Medical Mutual $285 127%
Meritain $285 127%
Trustmark Small Business Benefits $285 127%
Webtpa $285 127%
Oscar $301 - $17,621 135%
Crime Victim Assistance $304 136%
Centivo $305 - $17,894 136%
Ambetter / Centene $355 - $20,833 159%
Claimdoc $425 - $24,925 190%
Nova $425 - $24,925 190%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 204 N 4Th Ave E, Newton, IA 50208
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals