CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Anthony Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $98
Cash Discount Price: $119
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Anthony Hospital is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.44x the Medicare baseline. Located in 2801 St Anthony Way, Pendleton, OR.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $119 (53%)

Insurance Median: $98 (44%)

Cash: $119 (53% of Medicare)

Ins. Median: $98 (44% 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
Moda Health	$34 - $167	15%
Cigna	$56 - $137	25%
Blue Cross Blue Shield	$82 - $196	37%
First Choice	$88 - $208	39%
Healthnet	$93 - $220	42%
Pacificsource	$98 - $233	44%
Providence	$98 - $233	44%
Aetna	$98 - $233	44%
United	$98 - $233	44%

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 $119.
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 Anthony Hospital 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.