CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Valor Health

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $70
Cash Discount Price: $104
vs. Medicare Baseline: 0.31x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Valor Health is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.31x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $104 (46%)

Insurance Median: $70 (31%)

Cash: $104 (46% of Medicare)

Ins. Median: $70 (31% 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
Tricare	$7 - $70	3%
Blue Cross Blue Shield	$8 - $151	4%
Blue Shield Mcr Adv	$8 - $72	4%
Humana	$8 - $151	4%
Molina Mcr Adv - All Plans	$8 - $72	4%
Pacificsource Mcr Adv	$8 - $76	4%
Regence Bs Triwest - All Plans	$8 - $72	4%
Select Health Mcr Adv	$8	4%
UnitedHealthcare	$8 - $142	4%
Blue Shield Comm - All Other Plans	$12 - $146	5%
Pacificsource Comm - All Other Plans	$12 - $146	5%
Select Health Comm - All Other Plans	$12 - $146	5%
Moda Health - All Plans	$16 - $146	7%
Aetna	$18 - $128	8%
Cigna	$21 - $142	9%

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 $104.
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 Valor Health 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.