CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lost Rivers Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $169
Cash Discount Price: $160
vs. Medicare Baseline: 0.76x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lost Rivers Medical Center is $169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $160. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.76x the Medicare baseline. Located in 551 Highland Drive, Arco, ID.

Cash / Self-Pay

$160

Average discount available for prompt cash payment at this facility.

Insurance Median

$169

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: $160 (72%)

Insurance Median: $169 (76%)

Cash: $160 (72% of Medicare)

Ins. Median: $169 (76% 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	$15 - $143	7%
Blue Cross Blue Shield	$23 - $442	10%
Aetna	$24 - $236	11%
First Choice-All Plans	$24 - $234	11%
Altius Health Plan-All Plans	$25 - $244	11%
Pacificsource Navigator-All Other Plans	$25 - $239	11%
Regence Blue Shield-All Other Plans	$25 - $247	11%
Humana	$26 - $442	12%
Select Health Brightpath-All Other Plans	$113 - $398	51%
Ihcn Brightpath-All Other Plans	$120 - $420	54%
Va Pccc-All Plans	$122 - $429	55%
Ihcn Brightpath Mcr Adv	$126 - $442	56%
Molina Mcr Adv-All Plans	$126 - $442	56%
Pacificsource Mcr Adv	$126 - $442	56%
Regence/Brightpth Slhp Mcr	$126 - $442	56%
Select Health Mcr Adv	$126 - $442	56%
Prime Hlth Mcr Adv	$132 - $464	59%
Cigna	$186 - $234	83%
UnitedHealthcare	$190 - $239	85%
Provider Network Of America-All Plans	$403	180%

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 $160.
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 Lost Rivers 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.