CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Astera Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $179
Cash Discount Price: $166
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Astera Health is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $166. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.80x the Medicare baseline. Located in 421 11Th Street Nw, Wadena, MN.

Cash / Self-Pay

$166

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $166 (74%)

Insurance Median: $179 (80%)

Cash: $166 (74% of Medicare)

Ins. Median: $179 (80% 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 Plus Pmap [40002]	$46 - $5,128	21%
Ucare Pmap [30006]	$86 - $1,691	38%
Medica Pmap [10057]	$88 - $3,448	39%
Primewest Pmap [30003]	$88 - $3,448	39%
Blue Cross Blue Shield	$94 - $5,128	42%
Health Partners [10045]	$94 - $5,128	42%
Medica Nonpmap [10056]	$94 - $18,306	42%
Primewest Non Pmap [30004]	$94 - $5,128	42%
Ucare Non Pmap [30007]	$99 - $5,385	44%
Health Partners Pmap [10046]	$118	53%
Ucare Commercial [10705]	$163 - $175	73%
UnitedHealthcare	$175 - $182	78%
Multiplan	$188	84%
Sanford Health Plan [10120]	$200	89%
Aetna	$212	95%

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 $166.
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 Astera Health 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.