CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Coteau Des Prairies Health Care System

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $311
Cash Discount Price: $453
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Coteau Des Prairies Health Care System is $311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $453. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.39x the Medicare baseline. Located in 205 Orchard Dr, Sisseton, SD.

Cash / Self-Pay

$453

Average discount available for prompt cash payment at this facility.

Insurance Median

$311

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: $453 (202%)

Insurance Median: $311 (139%)

Cash: $453 (202% of Medicare)

Ins. Median: $311 (139% 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
Humana	$148 - $172	66%
Indian Health Service	$148 - $172	66%
Medica	$148 - $312	66%
UnitedHealthcare	$148 - $359	66%
Primwest Health	$158 - $182	71%
Blue Cross Blue Shield	$338 - $400	151%
Avera Health Plan	$428 - $494	191%
Sanford Health Plan	$436 - $504	195%

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 $453.
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 Coteau Des Prairies Health Care 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.