CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $124
Cash Discount Price: $213
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Iowa Specialty Hospital - Clarion is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $213. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.55x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$213

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $213 (95%)

Insurance Median: $124 (55%)

Cash: $213 (95% of Medicare)

Ins. Median: $124 (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.

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
Tricare	$8 - $199	4%
Triwest Va - All Plans	$8 - $199	4%
Healthscope Stellar-All Plans	$13 - $338	6%
Aetna	$16 - $545	7%
UnitedHealthcare	$29 - $609	13%
Wellmark Hmo	$31 - $195	14%
Health Partners Ish-All Other Plans	$32 - $513	14%
Cigna	$36 - $622	16%
Midlands Choice-All Plans	$36 - $622	16%
Wellmark Ppo - All Other Plans	$38 - $214	17%
Auxiant Clarion Schools-All Plans	$46 - $417	21%
Health Partners Prestage	$52 - $481	23%

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 $213.
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 Iowa Specialty Hospital - Clarion 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.