CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Cass County Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $41
Cash Discount Price: $59
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cass County Memorial Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.18x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $59 (26%)

Insurance Median: $41 (18%)

Cash: $59 (26% of Medicare)

Ins. Median: $41 (18% 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	$8 - $281	4%
American Hlth Mcr Adv - All Plans	$8 - $128	4%
Amerigroup Mcr Adv - All Other Plans	$8 - $124	4%
Iowa Total Care Mcr	$8 - $127	4%
Medica Mcr Adv	$8 - $124	4%
Tricare	$8 - $124	4%
Triwest - All Plans	$8 - $121	4%
UnitedHealthcare	$8 - $269	4%
Va Ccn - All Plans	$8 - $124	4%
Wellmark Mcr Adv	$8 - $126	4%
Iowa Total Care Comm - All Other Plans	$9 - $137	4%
Midlands Choice Medica Mcr	$9 - $59	4%
Wellmark Hmo	$15 - $195	7%
Wellmark Ppo - All Other Plans	$18 - $214	8%
Midlands Choice New Bus	$33 - $192	15%
Midlands Choice Pho (Ppo) - All Other Plans	$33 - $266	15%
Iowa Total Care Mcaid	$36 - $127	16%
Medicaid / KanCare	$36 - $128	16%
Molina Mcaid - All Plans	$36 - $127	16%
Medica Comm - All Other Plans	$40 - $260	18%
Multiplan - All Plans	$43 - $281	19%

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 $59.
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 Cass County Memorial 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.