CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Diley Ridge Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $319
- Cash Discount Price: $1,118
- vs. Medicare Baseline: 1.43x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Diley Ridge Medical Center is $319. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,118. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.43x the Medicare baseline. Located in 7911 Diley Road, Canal Winchester, OH.
Cash / Self-Pay
$1,118
Average discount available for prompt cash payment at this facility.
Insurance Median
$319
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: $1,118 (500%)
Insurance Median: $319 (143%)
Cash: $1,118 (500% of Medicare)
Ins. Median: $319 (143% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $186 - $2,648 | 83% |
| UnitedHealthcare | $186 - $5,185 | 83% |
| Aetna | $207 - $3,563 | 93% |
| Blue Cross Blue Shield | $207 - $9,407 | 93% |
| Hospice Mount Carmel | $211 - $2,522 | 94% |
| The Health Plan | $215 - $2,572 | 96% |
| American Postal Workers Secondary | $232 - $2,921 | 104% |
| Cigna | $232 - $2,921 | 104% |
| Health Partners | $232 - $2,921 | 104% |
| Healthgram | $232 - $2,921 | 104% |
| Mvp | $232 - $2,921 | 104% |
| Priority Health | $232 - $2,921 | 104% |
| Geha | $250 - $5,185 | 112% |
| Gravie Admin Services | $307 | 137% |
| Healthez | $307 | 137% |
| Meritain | $307 | 137% |
| Webtpa | $307 | 137% |
| Access Health | $319 | 143% |
| Acclaim | $319 | 143% |
| Administrative Concepts | $319 | 143% |
| Allegeant | $319 | 143% |
| Allied Benefit Systems | $319 | 143% |
| American Family | $319 | 143% |
| American Healthcare Alliance | $319 | 143% |
| American National | $319 | 143% |
| American Republic | $319 | 143% |
| Amerihealth | $319 | 143% |
| Aultcare | $319 | 143% |
| Automated Benefit Services | $319 | 143% |
| Auxiant | $319 | 143% |
| Benefit Administrative Systems,Llc | $319 | 143% |
| Boon Chapman | $319 | 143% |
| Cam Administrative Services | $319 | 143% |
| Christian Brother Services | $319 | 143% |
| Christian Brothers Holy Cross | $319 | 143% |
| Claimchoice Adminstrators | $319 | 143% |
| Comprehensive Benefits | $319 | 143% |
| Continental Life Insurance | $319 | 143% |
| Coventry | $319 | 143% |
| Custom Benefit Administrators | $319 | 143% |
| Cypress Benefit Administrators | $319 | 143% |
| Employee Benefit Concepts | $319 | 143% |
| Employee Benefit Management | $319 | 143% |
| Forest County Potawatomi | $319 | 143% |
| Freedom Life Insurance Company | $319 | 143% |
| Group Administrators | $319 | 143% |
| Group Marketing Services | $319 | 143% |
| Group Pension Administrators | $319 | 143% |
| Guardian | $319 | 143% |
| Health America | $319 | 143% |
| Health Choices | $319 | 143% |
| Healthcare Management Admin | $319 | 143% |
| Insight | $319 | 143% |
| Intercare | $319 | 143% |
| Jfp Benefit Management | $319 | 143% |
| Jp Farley Corporation | $319 | 143% |
| Key Benefit Administrator | $319 | 143% |
| Liberty Union Life Assurance Co | $319 | 143% |
| Lucent Health | $319 | 143% |
| Luminare Health | $319 | 143% |
| Magnacare | $319 | 143% |
| Medcost | $319 | 143% |
| Mutual Health Services | $319 | 143% |
| Mutual Of Omaha | $319 | 143% |
| Ncas | $319 | 143% |
| Nippon Life Ins | $319 | 143% |
| Nova | $319 | 143% |
| Painters Union Insurance Fund | $319 | 143% |
| Physicians Mutual | $319 | 143% |
| Plumbers Local 98 Insurance Fund | $319 | 143% |
| Prairie States | $319 | 143% |
| Preferred One | $319 | 143% |
| Primary Physician Care | $319 | 143% |
| Professional Benefit Administrators | $319 | 143% |
| Secureone Preferred United Plans | $319 | 143% |
| Siho Insurance Services | $319 | 143% |
| Sisco Benefits | $319 | 143% |
| The Loomis Company | $319 | 143% |
| Trustmark Small Business Benefits | $319 | 143% |
| U Of M Health Plan | $319 | 143% |
| Unicare | $319 | 143% |
| Unified Group Services | $319 | 143% |
| Us Health And Life | $319 | 143% |
| Valenz | $319 | 143% |
| Varipro | $319 | 143% |
| Wps | $319 | 143% |
| Medben | $342 - $512 | 153% |
| Oscar | $348 - $4,161 | 156% |
| Humana | $349 - $683 | 156% |
| First Health | $360 | 161% |
| Rural Carrier Health Benefit Plan | $389 - $3,563 | 174% |
| Enterprise Group Planning | $408 - $4,867 | 182% |
| Consociate | $417 | 186% |
| Health Ohio Network | $417 | 186% |
| Custom Design Benefits | $441 - $5,271 | 197% |
| Quality Care Partners | $477 - $5,700 | 213% |
| Caresource | $499 | 223% |
| Healthlink Inc | $512 | 229% |
| Medical Benefits Mutual | $512 | 229% |
| Ohio Health Choice | $512 | 229% |
| Ohio Ppo Connect | $512 | 229% |
| Medical Mutual | $520 | 232% |
| Ameriben | $546 | 244% |
| Luminare Health (Detroit) | $546 | 244% |
| Medi Share | $546 | 244% |
| Multiplan | $546 | 244% |
| Ohiohealthy | $546 | 244% |
| Osu Not Independent Choice | $546 | 244% |
| Phcs | $546 | 244% |
| Philadelphia American Life Insurance | $546 | 244% |
| Twin Valley Psychiatric | $546 | 244% |
| Health Smart | $581 | 260% |
| Crime Victim Assistance | $632 | 282% |
| Ohio Safe Program | $632 | 282% |
| Bccp | $683 | 305% |
| Medicaid / KanCare | $683 | 305% |
| Optima Health | $683 | 305% |
| Blue Benefit Administrators Of Massachusetts | $788 - $9,407 | 352% |
| Blue Care Network | $788 - $9,407 | 352% |
| Blue Distinction Transplant | $788 - $9,407 | 352% |
| Blue Shield - Ca | $788 - $9,407 | 352% |
| Blue Shield - Id (Regence) | $788 - $9,407 | 352% |
| Blue Shield - Ny Highmark Northeastern | $788 - $9,407 | 352% |
| Blue Shield - Ny Highmark Western | $788 - $9,407 | 352% |
| Blue Shield - Pa (Highmark) | $788 - $9,407 | 352% |
| Blue Shield - Wa (Regence) | $788 - $9,407 | 352% |