CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Loring Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $99
Cash Discount Price: $110
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Loring Hospital is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $110. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.44x the Medicare baseline. Located in 211 Highland Avenue Po Box 217, Sac City, IA.

Cash / Self-Pay

$110

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $110 (49%)

Insurance Median: $99 (44%)

Cash: $110 (49% of Medicare)

Ins. Median: $99 (44% 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
Meritain	$23 - $32	10%
Bas	$34 - $48	15%
Aetna	$43 - $160	19%
Auxiant	$57 - $80	25%
Blue_Cross	$68 - $160	30%
Champva	$68 - $96	30%
Health_Partners	$68 - $96	30%
Admin_Concepts	$73 - $102	33%
UnitedHealthcare	$80 - $160	36%
Va	$86 - $120	38%
Champus	$87 - $122	39%
Humana	$100 - $160	45%
Healthscope	$103 - $144	46%
Midlands_Choice	$107 - $150	48%
Cigna	$109 - $154	49%

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 $110.
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 Loring 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.