CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $32
  • Cash Discount Price: $211
  • vs. Medicare Baseline: 0.14x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Anthony Regional Hospital & Nursing Home is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.14x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.
Cash / Self-Pay
$211

Average discount available for prompt cash payment at this facility.

Insurance Median
$32

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: $211 (94%)
Insurance Median: $32 (14%)
Cash: $211 (94% of Medicare)
Ins. Median: $32 (14% 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.

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 - $344 4%
Humana $8 - $325 4%
Ia Total Care Mcr $8 - $142 4%
Medica Mcr - All Plans $8 - $138 4%
UnitedHealthcare $8 - $308 4%
Va Ccn - All Plans $8 - $138 4%
Wellpoint Mcr Adv $8 - $138 4%
Ia Total Care Comm - All Other Plans $10 - $179 4%
Wellmark Hmo $15 - $328 7%
Ia Total Care Mcaid $16 - $157 7%
Wellpoint Mcaid - All Other Plans $16 - $157 7%
Molina Mcaid - All Plans $17 - $160 8%
Wellmark Ppo-All Other Plans $18 - $361 8%
Midlands Choice - All Plans $38 - $359 17%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 311 South Clark Street, Carroll, IA 51401
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals