CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Madison County Health Care System

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $86
  • Cash Discount Price: $106
  • vs. Medicare Baseline: 0.38x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Madison County Health Care System is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.38x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.
Cash / Self-Pay
$106

Average discount available for prompt cash payment at this facility.

Insurance Median
$86

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: $106 (47%)
Insurance Median: $86 (38%)
Cash: $106 (47% of Medicare)
Ins. Median: $86 (38% 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
Amerigroup Mcaid-All Plans $15 - $83 7%
Iowa Total Care Mcaid-All Plans $15 - $78 7%
Molina Mcaid/Chip -All Plans $15 - $81 7%
UnitedHealthcare $15 - $150 7%
Madison County Sheriff-All Plans $16 - $84 7%
Aetna $20 - $287 9%
Corvel Wc-All Plans $28 - $150 13%
Choicecare-All Plans $29 - $159 13%
First Choice-All Plans $29 - $159 13%
First Health-All Plans $29 - $159 13%
Integrated Hp-All Plans $29 - $159 13%
Mutual Of Omaha-All Plans $29 - $159 13%
Plaines Health-All Plans $29 - $159 13%
Preferred Hlth Ntwork-All Plans $29 - $159 13%
Principal Healthcare-All Plans $29 - $159 13%
Usa Managed Care-All Plans $29 - $159 13%
Medimore Employee Hp - All Plans $30 - $164 13%
Midlands Choice - All Plans $30 - $164 13%
Benefit Admin Of America-All Plans $31 - $167 14%
Medical Associates Hp - All Plans $57 - $287 25%
Medigold-All Plans $57 - $287 25%
Tricare $57 - $287 25%
American Hp Mcr Adv-All Plans $60 - $302 27%
Oscar - All Plans $86 - $431 38%
Blue Cross Blue Shield $328 - $361 147%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 300 West Hutchings Street, Winterset, IA 50273
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Local
  • Hospital Type: Critical Access Hospitals