CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Portneuf Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $341
Cash Discount Price: $242
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Portneuf Medical Center is $341. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $242. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.52x the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$242

Average discount available for prompt cash payment at this facility.

Insurance Median

$341

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: $242 (108%)

Insurance Median: $341 (152%)

Cash: $242 (108% of Medicare)

Ins. Median: $341 (152% 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
Bannock County Jail [6050]	$68	30%
Department Of Corrections [1340]	$68	30%
Medicaid / KanCare	$68	30%
UnitedHealthcare	$68 - $362	30%
Pending County Rca [3910]	$69	31%
Aetna	$83 - $341	37%
Healthscope Benefits [2290]	$83	37%
Black Lung [6055]	$165	74%
Employee Benefit Management Services [2445]	$165 - $242	74%
Healthcare Highways [2210]	$165 - $382	74%
Lucent Health [6000]	$165	74%
Moda Health [6100]	$165	74%
Oncology Patient Assistance Programs [2295]	$165	74%
Pending Ssi [1616]	$165	74%
Web Tpa [2115]	$165	74%
Pacific Source Health Plans [2850]	$231	103%
Liberty Health Share Lhs/Medcost Solutions Llc [2400]	$242	108%
Medishare Christian Care [1645]	$242	108%
Multiplan [1680]	$270 - $382	121%
First Health [1375]	$332	148%
Mailhandlers [1595]	$341	152%
Selecthealth [3740]	$341 - $362	152%
Cigna	$355	159%
Geha [1415]	$362	162%
Humana	$362	162%
Administrative Concepts [1005]	$382	171%
Healthfirst [2395]	$382	171%
Healthnet [1495]	$382	171%
Hometown Health [2155]	$382	171%
Mayo Clinic Health Solutions [2280]	$382	171%
Meritain Health [1655]	$382	171%
Mutual Of Omaha [1685]	$382	171%
National Association Of Letter Carriers [1695]	$382	171%
New Era Life Insurance Company [1705]	$382	171%
Pan American Life Insurance Co [1770]	$382	171%
Pba [1775]	$382	171%
Phcs [1780]	$382	171%
Planned Administrators Inc [2360]	$382	171%
Trustmark [2030]	$382	171%
Ut Id Teamsters [3760]	$382	171%

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 $242.
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 Portneuf 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.