CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sanford Clear Lake Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $134
Cash Discount Price: $130
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sanford Clear Lake Medical Center is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.60x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $130 (58%)

Insurance Median: $134 (60%)

Cash: $130 (58% of Medicare)

Ins. Median: $134 (60% 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
Sanford Health Plan Align	$63 - $162	28%
Security Health Plan	$67 - $174	30%
Ucare	$67 - $278	30%
Wellmark Sd	$67 - $174	30%
Aetna	$68 - $275	30%
Health Partners	$68 - $237	30%
Medicare (plans)	$68 - $176	30%
UnitedHealthcare	$68 - $264	30%
Primewest	$69 - $179	31%
Sanford Health Plan	$85 - $294	38%
Blue Cross Blue Shield	$100 - $292	45%
Medica	$101 - $279	45%
Wellmark	$105 - $275	47%
Cigna	$110 - $284	49%
First Choice Health Network	$110 - $284	49%
Healthez	$110 - $284	49%
Multiplan	$110 - $284	49%

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 $130.
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 Sanford Clear Lake Medical Center 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.