CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Luke's Wood River Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $417
Cash Discount Price: $463
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Luke's Wood River Medical Center is $417. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $463. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.86x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$463

Average discount available for prompt cash payment at this facility.

Insurance Median

$417

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: $463 (207%)

Insurance Median: $417 (186%)

Cash: $463 (207% of Medicare)

Ins. Median: $417 (186% 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
Commercial [1028]	$264 - $449	118%
Medicare (plans)	$264 - $269	118%
Veterans Affairs [1056]	$264	118%
Blue Cross Blue Shield	$267 - $396	119%
UnitedHealthcare	$277 - $419	124%
Aetna	$290 - $440	130%
Moda [1055]	$407	182%
Geha [1065]	$419	187%
United Medical Resources [1051]	$419	187%
Cigna	$431	193%
Providence [1022]	$431	193%
Pacificsource [1020]	$435	194%
First Health [1064]	$440 - $449	197%
Webtpa [1071]	$440	197%

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 $463.
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 St Luke's Wood River 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.