CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Avita Ontario

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $3,049
Cash Discount Price: $48
vs. Medicare Baseline: 13.63x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Avita Ontario is $3,049. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 13.63x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,049

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: $48 (21%)

Insurance Median: $3,049 (1363%)

Cash: $48 (21% of Medicare)

Ins. Median: $3,049 (1363% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1363% of the Medicare baseline (a markup of 1263%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Molina	$29 - $5,629	13%
Blue Cross Blue Shield	$34 - $3,518	15%
Cigna	$44	20%
Aetna	$48 - $3,588	21%
United_Healthcare	$48 - $3,354	21%
Caresource	$110	49%
Medicaid / KanCare	$110	49%
Ohiorise	$110	49%
Amerihealth	$115	51%
Buckeye	$119 - $3,518	53%
Humana	$119 - $3,518	53%
Medical_Mutual	$554 - $3,588	248%
Medicare (plans)	$3,048 - $3,518	1362%
Mount_Carmel	$3,048 - $3,518	1362%

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 $48.
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 Avita Ontario 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.