CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sanford Canton-Inwood Medical Center - Cah

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $206
Cash Discount Price: $222
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sanford Canton-Inwood Medical Center - Cah is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.92x the Medicare baseline. Located in 440 North Hiawatha Drive, Canton, SD.

Cash / Self-Pay

$222

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

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: $222 (99%)

Insurance Median: $206 (92%)

Cash: $222 (99% of Medicare)

Ins. Median: $206 (92% 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	$95	42%
Ucare	$102 - $243	46%
Wellmark	$102 - $241	46%
Aetna	$103 - $241	46%
Health Partners	$103 - $208	46%
Medicare (plans)	$103	46%
UnitedHealthcare	$103 - $231	46%
Primewest	$105	47%
Sanford Health Plan	$152 - $204	68%
Security Health Plan	$152	68%
Medica	$229 - $244	102%
First Choice Health Network	$249	111%
Healthez	$249	111%
Multiplan	$249	111%

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 $222.
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 Canton-Inwood Medical Center - Cah 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.