CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mercyone Clinton Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $314
  • Cash Discount Price: $366
  • vs. Medicare Baseline: 1.40x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercyone Clinton Medical Center is $314. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $366. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.40x the Medicare baseline. Located in 1410 North 4Th Street, Clinton, IA.
Cash / Self-Pay
$366

Average discount available for prompt cash payment at this facility.

Insurance Median
$314

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: $366 (164%)
Insurance Median: $314 (140%)
Cash: $366 (164% of Medicare)
Ins. Median: $314 (140% 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
Health Choices $159 71%
Medical Associates $159 71%
Preferred Health Choice $163 73%
Geha $174 78%
UnitedHealthcare $174 - $563 78%
Iowa Total Care $202 90%
Medicaid / KanCare $204 91%
Bcn Domestic $224 100%
Blue Benefit Administrators Of Massachusetts $224 100%
Blue Care Network $224 100%
Blue Cross Blue Shield $224 - $231 100%
Blue Distinction Transplant $224 100%
Blue Shield - Ca $224 100%
Blue Shield - Id (Regence) $224 100%
Blue Shield - Ny Highmark Northeastern $224 100%
Blue Shield - Ny Highmark Western $224 100%
Blue Shield - Pa (Highmark) $224 100%
Blue Shield - Wa (Regence) $224 100%
Kaiser Domestic $224 100%
Pre-Employment $224 100%
Wc Domestic $224 100%
Aetna $228 - $493 102%
Medicare (plans) $228 - $238 102%
Amish Hospital Aid $310 139%
Oscar $318 142%
The Alliance $341 152%
Ambetter / Centene $392 175%
Claimdoc $469 210%
Nova $469 210%
1199 National Benefit Fund $493 220%
Allied Benefit Systems $493 220%
Asr Health Benefits $493 220%
Christian Brother Services $493 220%
Coventry $493 220%
First Health $493 220%
Lucent Health $493 220%
Luminare Health $493 220%
Medical Mutual $493 220%
Meritain $493 220%
Trustmark Small Business Benefits $493 220%
Webtpa $493 220%
Health Partners $494 221%
Auxiant $507 227%
Cigna $507 227%
Medica $507 227%
Midlands $507 227%
Midlands Choice $507 227%
Multiplan $507 227%
Qualcare $507 227%
Usa Managed Care $535 239%
Crime Victim Assistance $563 252%
Iowa Dept Of Public Health $563 252%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1410 North 4Th Street, Clinton, IA 52732
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals