CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $79
- Cash Discount Price: $43
- vs. Medicare Baseline: 0.35x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Saint Alphonsus Medical Center Ontario is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.35x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$43
Average discount available for prompt cash payment at this facility.
Insurance Median
$79
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: $43 (19%)
Insurance Median: $79 (35%)
Cash: $43 (19% of Medicare)
Ins. Median: $79 (35% 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 |
|---|---|---|
| Medicaid / KanCare | $5 - $79 | 2% |
| Oregon Screenwise | $6 - $79 | 3% |
| UnitedHealthcare | $8 - $255 | 4% |
| Moda Health | $14 - $506 | 6% |
| Mountain Health Co-Op | $14 - $158 | 6% |
| Selecthealth | $14 - $238 | 6% |
| Asuris Northwest Health | $15 | 7% |
| Blue Shield - Id (Regence) | $15 - $798 | 7% |
| Healthcare Management Admin | $15 - $784 | 7% |
| Humana | $17 - $232 | 8% |
| Cigna | $22 - $248 | 10% |
| Pacificsource Health Plans | $22 - $248 | 10% |
| Geha | $23 - $253 | 10% |
| Ada County Jail Inmate Ins | $79 | 35% |
| Aetna | $79 - $263 | 35% |
| Ambetter / Centene | $79 | 35% |
| Amish Mennonite | $79 | 35% |
| Bcccp-Michigan | $79 | 35% |
| Bccp | $79 | 35% |
| Blue Cross Blue Shield | $79 - $798 | 35% |
| Bmc Healthnet | $79 | 35% |
| Breast Grant-Connecticut | $79 | 35% |
| California Health And Wellness | $79 | 35% |
| Cardinal Innovations Lme | $79 | 35% |
| Care Oregon Ohp | $79 | 35% |
| Cencal Health Plan | $79 | 35% |
| Cenpatico | $79 | 35% |
| Centurion Of Idaho | $79 | 35% |
| Chhuny | $79 | 35% |
| Childrens Comm Health Plan | $79 | 35% |
| Childrens Medical Services Title 19 | $79 | 35% |
| Community Benefit Health | $79 | 35% |
| Community Care Behavorial Health | $79 | 35% |
| Community Health Choice | $79 | 35% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $79 | 35% |
| Dean Wi Badgercare | $79 | 35% |
| Delaware First Health | $79 | 35% |
| Delta Dental Nj | $79 | 35% |
| Dph Tb Program | $79 | 35% |
| Dscc | $79 | 35% |
| Eastpointe Lme | $79 | 35% |
| Family Health Network | $79 | 35% |
| Freedom First Healthcare | $79 | 35% |
| Ghc Scw Wi Badgercare | $79 | 35% |
| Harbor Health | $79 | 35% |
| Health Safety Net | $79 | 35% |
| Healthy Blue Ne | $79 | 35% |
| Hennepin Health | $79 | 35% |
| Id County Ada | $79 | 35% |
| Id County Canyon | $79 | 35% |
| Id County Cat Fund | $79 | 35% |
| Id County Payette | $79 | 35% |
| Idaho Womens Health Check | $79 | 35% |
| Indiana Breast Cervical Cancer | $79 | 35% |
| Inland Empire Health Plan | $79 | 35% |
| Intercommunity Health Ohp | $79 | 35% |
| Iowa Total Care | $79 | 35% |
| Jai Medical System | $79 | 35% |
| Kern Family Health Plan | $79 | 35% |
| Keystone First | $79 | 35% |
| Keystone First Chip | $79 | 35% |
| La Care Health Plan | $79 | 35% |
| Lakeland Care Inc | $79 | 35% |
| Managed Health Services - Indiana | $79 | 35% |
| Maryland Breast & Cervical Program | $79 | 35% |
| Maryland Healthy Smiles - Scion Dental | $79 | 35% |
| Maryland Physicians Care | $79 | 35% |
| Massachusetts Behavioral Health Partnership | $79 | 35% |
| Mdwise | $79 | 35% |
| Medi-Cal | $79 | 35% |
| Medi-Cal Healthnet | $79 | 35% |
| Medstar Dc Healthy Family | $79 | 35% |
| Medstar Md Health Choice | $79 | 35% |
| Mo Home State Health Plan | $79 | 35% |
| Molina Centennial Care | $79 | 35% |
| Nascentia Health Options | $79 | 35% |
| Nebraska Total Care | $79 | 35% |
| New York Cancer Services Program | $79 | 35% |
| Nextlevel Health | $79 | 35% |
| Pace Of Southwest Michigan | $79 | 35% |
| Paramount Advantage | $79 | 35% |
| Parkland Community Health Plan | $79 | 35% |
| Partners Behavioral Lme | $79 | 35% |
| Peach State Healthplan | $79 | 35% |
| Presbyterian Centennial Care | $79 | 35% |
| Prestige Health Choice | $79 | 35% |
| Priority Partners | $79 | 35% |
| Rx 340B Pass Along | $79 | 35% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $79 | 35% |
| Rx Medi-Cal | $79 | 35% |
| Rx Meridian Rx | $79 | 35% |
| Sandhills Center Lme | $79 | 35% |
| Screening For Life | $79 | 35% |
| Sunshine State Health Plan | $79 | 35% |
| Superior Health | $79 | 35% |
| Tenncare | $79 | 35% |
| Texas Children'S Health Plan | $79 | 35% |
| Trillium Community Ohp | $79 | 35% |
| Tufts Health Public Plans | $79 | 35% |
| Vaya Health Lme | $79 | 35% |
| Wellsense Health Plan | $79 | 35% |
| Wi Womens Wellness | $79 | 35% |
| Allegiance | $201 | 90% |
| Correctional Health Partners | $206 | 92% |
| Columbia Health Network | $211 | 94% |
| Healthnet | $222 | 99% |
| Allied National Global Care | $238 | 106% |
| Asrm - Reliance Standard Life Insurance | $238 | 106% |
| Christian Care Ministry | $238 | 106% |
| Dean Health | $238 | 106% |
| Fallon Health | $238 | 106% |
| Family Life Insurance Company | $238 | 106% |
| First Choice Health | $238 | 106% |
| Ghc Scw | $238 | 106% |
| International Benefit Administrators | $238 | 106% |
| Lifetime Benefit Solutions | $238 | 106% |
| Manhattan Life | $238 | 106% |
| Pai | $238 | 106% |
| Pan-American Life | $238 | 106% |
| Paramount Hmo | $238 | 106% |
| Phcs | $238 | 106% |
| Trinity Health Share | $238 | 106% |
| Webtpa | $238 - $688 | 106% |
| Lifewise | $246 | 110% |
| Priority Health | $248 | 111% |
| Allied Benefit Systems | $250 | 112% |
| Ameriben | $250 | 112% |
| Asr Health Benefits | $250 | 112% |
| Christian Brother Services | $250 | 112% |
| Healthez | $250 | 112% |
| Luminare Health (Detroit) | $250 | 112% |
| Rural Carrier Health Benefit Plan | $250 | 112% |
| First Health | $251 | 112% |
| Medi Share | $251 | 112% |
| Providence | $251 | 112% |
| Medicare (plans) | $255 - $274 | 114% |
| American Health Advantage Of Idaho | $266 | 119% |
| Blue Benefit Administrators Of Massachusetts | $798 | 357% |
| Blue Care Network | $798 | 357% |
| Blue Distinction Transplant | $798 | 357% |
| Blue Shield - Ca | $798 | 357% |
| Blue Shield - Ny Highmark Northeastern | $798 | 357% |
| Blue Shield - Ny Highmark Western | $798 | 357% |
| Blue Shield - Pa (Highmark) | $798 | 357% |
| Blue Shield - Wa (Regence) | $798 | 357% |