CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Essentia Health St Joseph's Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $135
Cash Discount Price: $123
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Essentia Health St Joseph's Medical Center is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.60x the Medicare baseline. Located in 523 North 3Rd Street, Brainerd, MN.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$135

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: $123 (55%)

Insurance Median: $135 (60%)

Cash: $123 (55% of Medicare)

Ins. Median: $135 (60% 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
Medica Access	$49 - $66	22%
Healthpartners Care Pmap	$67 - $90	30%
Sanford Health Plan	$67 - $94	30%
Blue Cross Blue Shield	$70 - $541	31%
Blue Plus Pmap Pcc Prime	$70 - $726	31%
Medica	$99 - $148	44%
Medica Uplan	$99 - $133	44%
Ucare	$103 - $138	46%
Wea	$112 - $161	50%
Medica Choice	$114 - $152	51%
Cigna	$115 - $154	51%
Healthpartners	$115 - $154	51%
Healthpartners Pcc Prime	$115 - $154	51%
UnitedHealthcare	$119 - $218	53%
America'S Ppo	$121 - $162	54%
Wps	$129 - $176	58%
Aetna	$133 - $178	59%
Itasca Med Care	$203	91%
Primewest	$206	92%
Advocare/Security Health	$218	97%
Freedom Blue Ppo	$218	97%
Healthpartners Care Msho / Mcr Adv	$218	97%
Imcare Msho Pcc Prime	$218	97%
Imcare Msho Ref Req	$218	97%
Medica Advantage Solutions	$218	97%
Medica Msho/Dual Solutions	$218	97%
Medica Prime Solution Group	$218	97%
Medicare (plans)	$218	97%
Nd Va Administration	$218	97%
Platinum Blue/Vantage Blue	$218	97%
Primewest Msho	$218	97%
Secure Blue Msho	$218	97%
Ubh Cost Plan	$218	97%
Ubh Msho	$218	97%
Ucare Msho	$218	97%

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 $123.
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 Essentia Health St Joseph's 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.