CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Franklin General Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $73
Cash Discount Price: $93
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Franklin General Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.33x the Medicare baseline. Located in 1720 Central Avenue East, Hampton, IA.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $93 (42%)

Insurance Median: $73 (33%)

Cash: $93 (42% of Medicare)

Ins. Median: $73 (33% 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
Wellmark Mcr Adv	$31 - $52	14%
Ambetter / Centene	$32 - $382	14%
Amerigroup Mcaid - All Other Plans	$33 - $54	15%
Molina Mcaid - All Other Plans	$33 - $55	15%
Medical Ass Hosp Employer Group	$46 - $77	21%
Amerigroup Mcare	$52 - $241	23%
Medical Associates Mcare	$52 - $239	23%
Mount Carmel Hp-All Plans	$52 - $239	23%
Tricare	$52 - $239	23%
UnitedHealthcare	$52 - $107	23%
American Hp Iowa - All Plans	$54 - $251	24%
Midlands Choice-All Plans	$54 - $90	24%
Molina Mcare	$54 - $248	24%
Medical Associates Hp-All Other Plans	$65 - $110	29%
Preferred Health Choices-All Plans	$65 - $110	29%
Splashlight Llc-All Plans	$65 - $110	29%
Aetna	$72 - $123	32%
Multiplan-All Plans	$73 - $123	33%
Centivo - All Plans	$77 - $358	34%
Oscar - All Plans	$77 - $358	34%
Wellmark Hmo	$328	147%
Wellmark Ppo - All Other Plans	$361	161%

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 $93.
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 Franklin General Hospital 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.