CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Monroe County Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $72
Cash Discount Price: $86
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Monroe County Hospital is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.32x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $86 (38%)

Insurance Median: $72 (32%)

Cash: $86 (38% of Medicare)

Ins. Median: $72 (32% 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
Amerigroup Mcare	$53 - $62	24%
Humana	$53 - $62	24%
Mahp Mcare - All Plans	$53 - $62	24%
Tricare	$53 - $62	24%
UnitedHealthcare	$53 - $140	24%
Va Ccn - All Plans	$53 - $62	24%
Wellmark Mcare	$53 - $62	24%
Aetna	$54 - $138	24%
Iowa Total Care Mcaid - All Plans	$63 - $73	28%
Molina Mcaid - All Plans	$64 - $75	29%
Amerigroup Mcaid - All Other Plans	$65 - $76	29%
Wellmark Hmo	$71	32%
Wellmark Ppo - All Other Plans	$77	34%
Centivo - All Plans	$79 - $93	35%
Midlands Choice - All Plans	$88 - $103	39%
Preferred Hlth - All Plans	$94 - $110	42%
Geha - All Plans	$101 - $118	45%
Multiplan - All Plans	$113 - $132	51%
Integrated Hp - All Plans	$122 - $143	55%

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 $86.
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 Monroe County 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.