CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Brookings Health System

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $321
Cash Discount Price: $219
vs. Medicare Baseline: 1.43x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Brookings Health System is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $219. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.43x the Medicare baseline. Located in 300 22Nd Ave, Brookings, SD.

Cash / Self-Pay

$219

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $219 (98%)

Insurance Median: $321 (143%)

Cash: $219 (98% of Medicare)

Ins. Median: $321 (143% 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_Msho	$172	77%
Medica_Choice_Care	$176	79%
Medicare (plans)	$218	97%
Blue Cross Blue Shield	$229	102%
Medica	$321	143%
Medica_Accessibility_Solution	$321	143%
Medica_Selectcare	$321	143%
UnitedHealthcare	$363	162%
Avera	$394	176%
Humana	$394	176%
Sanford_Bhcag	$416	186%
Multiplan	$425	190%
Medicaid / KanCare	$438	196%

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 $219.
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 Brookings Health System 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.