CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Kossuth Regional Health Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $27
Cash Discount Price: $111
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Kossuth Regional Health Center is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.12x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $111 (50%)

Insurance Median: $27 (12%)

Cash: $111 (50% of Medicare)

Ins. Median: $27 (12% 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 Mcr Adv - All Other Plans	$8	4%
Humana	$8	4%
Mercy One - All Plans	$8	4%
Sanford Pho Isno Mcr Adv Profee Only - All Plans	$8	4%
UnitedHealthcare	$8 - $42	4%
Va Ccn - All Plans	$8	4%
Medical Associates - All Plans	$13	6%
Preferred Health - All Plans	$13	6%
Blue Cross Blue Shield	$15 - $18	7%
Midlands Choice - All Plans	$21	9%
Aetna	$27 - $28	12%
Health Partners New Bus - All Other Plans	$29	13%
Health Partners Exisiting Bus	$32	14%
Multiplan - All Plans	$131 - $132	59%
Molina Mcaid/Chip - All Plans	$141 - $143	63%
Amerigroup Mcaid	$142 - $144	63%

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 $111.
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 Kossuth Regional Health Center 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.