CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Boone County Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $55
Cash Discount Price: $90
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Boone County Hospital is $55. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.25x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$55

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: $90 (40%)

Insurance Median: $55 (25%)

Cash: $90 (40% of Medicare)

Ins. Median: $55 (25% 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
Aetna	$15 - $109	7%
Amerigroup Mcr Adv - All Other Plans	$15 - $58	7%
Choice Care Mcr Adv - All Plans	$15 - $57	7%
Humana	$15 - $126	7%
Iowa Hlth Adv - All Plans	$15 - $57	7%
Mt Carmel Hp - All Plans	$15 - $57	7%
UnitedHealthcare	$15 - $82	7%
Va Ccn-All Plans	$15 - $57	7%
Meridian Mcaid - All Plans	$16 - $63	7%
Iowa Total Care Mcaid - All Plans	$17 - $64	8%
Medicaid / KanCare	$17 - $65	8%
Healthsmart Accell Network	$25 - $98	11%
Medical Associates Hp-All Plans	$27 - $105	12%
Healthsmart Ppo - All Other Plans	$29 - $112	13%
Health Alliance-All Plans	$32 - $126	14%
Midlands Choice-All Plans	$33 - $128	15%
Mutually Preferred-All Plans	$34 - $133	15%
Tricare	$224	100%
Wellmark Hmo	$433	194%
Wellmark Ppo - All Other Plans	$475	212%

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 $90.
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 Boone 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.