CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Perham Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $70
Cash Discount Price: $95
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Perham Health is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.31x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $95 (42%)

Insurance Median: $70 (31%)

Cash: $95 (42% of Medicare)

Ins. Median: $70 (31% 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	$24 - $210	11%
Health Partners Mcr Adv	$30 - $106	13%
Humana	$30 - $106	13%
Medica Mcr Adv	$30 - $106	13%
Medicare (plans)	$30 - $124	13%
Ucare Mn Senior Health Options	$30 - $106	13%
UnitedHealthcare	$30 - $243	13%
Medicaid / KanCare	$31 - $112	14%
Ucare Mn Medical Assistance	$31 - $112	14%
Ucare Mn Minnesota Care	$31 - $112	14%
Ucare Mn Senior Care Plus	$31 - $112	14%
Ucare Mn Special Needs Basic Care	$31 - $112	14%
Ucare Mn Special Needs Basic Care Dual	$31 - $111	14%
Medica Mcaid Mn Care	$32 - $167	14%
Medica Mn (Msho)	$36 - $128	16%
Ucare Individual And Family Plan-All Other Plans	$36 - $156	16%
Medica Mn Senior Hp/Outside Mn	$40 - $142	18%
Health Partners Minnesota Care	$44 - $156	20%
Medica Commercial-All Other Plans	$64 - $228	29%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$65 - $233	29%
Health Partners-All Plans	$71 - $255	32%
Preferred One (Ppo)	$74 - $264	33%
Sanford Health Plan-All Plans	$74 - $264	33%

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 $95.
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 Perham 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.