CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mercyone Dyersville Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $251
Cash Discount Price: $198
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mercyone Dyersville Medical Center is $251. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $198. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.12x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.

Cash / Self-Pay

$198

Average discount available for prompt cash payment at this facility.

Insurance Median

$251

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: $198 (89%)

Insurance Median: $251 (112%)

Cash: $198 (89% of Medicare)

Ins. Median: $251 (112% 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
Health Choices	$115	51%
Blue Cross Blue Shield	$169	76%
Medicare (plans)	$172 - $188	77%
UnitedHealthcare	$180 - $274	80%
The Alliance	$185	83%
Iowa Total Care	$211	94%
Medicaid / KanCare	$214 - $215	96%
Amish Hospital Aid	$226	101%
1199 National Benefit Fund	$251	112%
Aetna	$251	112%
Allied Benefit Systems	$251	112%
Asr Health Benefits	$251	112%
Christian Brother Services	$251	112%
Coventry	$251	112%
First Health	$251	112%
Luminare Health	$251	112%
Medical Mutual	$251	112%
Meritain	$251	112%
Trustmark Small Business Benefits	$251	112%
Webtpa	$251	112%
Auxiant	$274	122%
Cigna	$274	122%
Geha	$274	122%
Medica	$274	122%
Midlands	$274	122%
Midlands Choice	$274	122%
Multiplan	$274	122%
Ambetter / Centene	$286	128%
Crime Victim Assistance	$304	136%
Iowa Dept Of Public Health	$304	136%
Claimdoc	$342	153%
Nova	$342	153%

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 $198.
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 Mercyone Dyersville Medical 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.