CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Essentia Health Sandstone

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $78
Cash Discount Price: $100
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Essentia Health Sandstone is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.35x the Medicare baseline. Located in 705 Lundorff Drive South, Sandstone, MN.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $100 (45%)

Insurance Median: $78 (35%)

Cash: $100 (45% of Medicare)

Ins. Median: $78 (35% 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
Blue Cross Blue Shield	$26 - $163	12%
Blue Plus Pmap Pcc Prime	$26 - $112	12%
Healthpartners Care Pmap	$27 - $82	12%
Medica Access	$27 - $126	12%
Sanford Healthplan	$29 - $92	13%
Advocare/Security Health	$31 - $95	14%
Freedom Blue Ppo	$31 - $95	14%
Healthpartners Care Msho / Mcr Adv	$31 - $95	14%
Imcare Msho Pcc Prime	$31 - $95	14%
Imcare Msho Ref Req	$31 - $95	14%
Medica Advantage Solutions	$31 - $95	14%
Medica Msho/Dual Solutions	$31 - $95	14%
Medica Prime Solution Group	$31 - $95	14%
Medicare (plans)	$31 - $95	14%
Nd Va Administration	$31 - $95	14%
Platinum Blue/Vantage Blue	$31 - $95	14%
Primewest Msho	$31 - $95	14%
Secure Blue Msho	$31 - $95	14%
Ubh Cost Plan	$31 - $95	14%
Ubh Msho	$31 - $95	14%
Ucare Msho	$31 - $95	14%
UnitedHealthcare	$31 - $185	14%
Ucare	$44 - $134	20%
Healthpartners	$45 - $162	20%
Medica	$48 - $161	21%
Medica Uplan	$48 - $145	21%
Wea	$48 - $156	21%
America'S Ppo	$52 - $157	23%
Cigna	$52 - $162	23%
Healthpartners Pcc Prime	$52 - $162	23%
Medica Choice	$55 - $166	25%
Wps	$56 - $171	25%
Aetna	$57 - $173	25%
Security Health	$67 - $203	30%
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 $100.
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 Sandstone 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.