CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ortonville Area Health Services

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $49
Cash Discount Price: $50
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ortonville Area Health Services is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.22x the Medicare baseline. Located in 450 Eastvold Ave, Ortonville, MN.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $50 (22%)

Insurance Median: $49 (22%)

Cash: $50 (22% of Medicare)

Ins. Median: $49 (22% 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	$20 - $90	9%
Medica	$26 - $45	12%
Medica Minnesota Senior Health Options (Msho)/Select Solution/Prime Solution	$26 - $45	12%
Primewest	$26 - $45	12%
Ucare Health	$26 - $45	12%
UnitedHealthcare	$26 - $82	12%
Health Partners	$28 - $83	13%
Medica Choicecare/Accessibility Solution/Minnesotacare	$33 - $56	15%
Sanford Health Plan	$51 - $86	23%
Multiplan	$52 - $87	23%
America'S Health System	$53 - $90	24%
Medica Choice/Focus/Ifb/Mhps/Care System	$53 - $90	24%

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 $50.
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 Ortonville Area Health Services 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.