CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Essentia Health Virginia

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $133
Cash Discount Price: $87
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Essentia Health Virginia is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.59x the Medicare baseline. Located in 901 9Th Street North, Virginia, MN.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $87 (39%)

Insurance Median: $133 (59%)

Cash: $87 (39% of Medicare)

Ins. Median: $133 (59% 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	$16 - $48	7%
Healthpartners Care Pmap	$27 - $83	12%
Sanford Healthplan	$30 - $360	13%
Blue Cross Blue Shield	$31 - $520	14%
Blue Plus Pmap Pcc Prime	$32 - $140	14%
Medica	$44 - $148	20%
Medica Uplan	$44 - $133	20%
Ucare	$45 - $138	20%
Healthpartners	$49 - $189	22%
Medica Choice	$50 - $152	22%
Wea	$50 - $161	22%
America'S Ppo	$53 - $162	24%
Security Health	$53 - $161	24%
Wps	$57 - $176	25%
Aetna	$59 - $178	26%
UnitedHealthcare	$61 - $200	27%
Cigna	$62 - $189	28%
Healthpartners Pcc Prime	$62 - $189	28%
Advocare/Security Health	$200	89%
Freedom Blue Ppo	$200	89%
Healthpartners Care Msho / Mcr Adv	$200	89%
Imcare Msho Pcc Prime	$200	89%
Imcare Msho Ref Req	$200	89%
Medica Advantage Solutions	$200	89%
Medica Msho/Dual Solutions	$200	89%
Medica Prime Solution Group	$200	89%
Medicare (plans)	$200	89%
Nd Va Administration	$200	89%
Platinum Blue/Vantage Blue	$200	89%
Primewest Msho	$200	89%
Secure Blue Msho	$200	89%
Ubh Cost Plan	$200	89%
Ubh Msho	$200	89%
Ucare Msho	$200	89%
Itasca Med Care	$203	91%
Primewest	$206	92%

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 $87.
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 Virginia 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.