CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sky Lakes Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $226
Cash Discount Price: $177
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sky Lakes Medical Center is $226. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.01x the Medicare baseline. Located in 2865 Daggett Avenue, Klamath Falls, OR.

Cash / Self-Pay

$177

Average discount available for prompt cash payment at this facility.

Insurance Median

$226

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: $177 (79%)

Insurance Median: $226 (101%)

Cash: $177 (79% of Medicare)

Ins. Median: $226 (101% 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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Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

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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
Moda Health [1070]	$169 - $287	76%
Pacificsource [1195]	$185 - $258	83%
Pacificsource Health Plan PPO [1072]	$185 - $258	83%
Alaska Teamster [1116]	$205 - $287	92%
Wausau Ins [1100]	$205 - $287	92%
Corvel [3066]	$205 - $287	92%
Motion Picture Health [1066]	$205 - $287	92%
Tribal Health Coquille [1088]	$205 - $287	92%
Mega Life and Hlth [1065]	$205 - $287	92%
Pemco Mutual Insurance [6044]	$205 - $287	92%
Special District Assoc of Or [6024]	$205 - $287	92%
City County Ins Service [6007]	$205 - $287	92%
Managed Hlth Netwrk Bh Healthnet [1233]	$205 - $287	92%
The General [3055]	$205 - $287	92%
Healthnet PPO [1047]	$205 - $287	92%
Liberty Mutual [6049]	$205 - $287	92%
Cco Health Share Kaiser [5031]	$205 - $287	92%
Sentinel Security Life Insurance [1189]	$205 - $287	92%
Trustmark [1209]	$205 - $287	92%
Cco Pacifisource Community Sol [5016]	$205 - $287	92%
State Farm [6027]	$205 - $287	92%
United Teacher Assoc Ins Co [1171]	$205 - $287	92%
Matrix Absence Management Inc [6038]	$205 - $287	92%
Aflac Med Supp [1234]	$205 - $287	92%
Health Now Admin Services [1120]	$205 - $287	92%
Ohp Newborn Pending Id [8006]	$205 - $287	92%
Iac [1157]	$205 - $287	92%
Partnership Healthplan of Ca [5033]	$205 - $287	92%
Pyramid Life Insurance [1080]	$205 - $287	92%
Cypress Benefit Administrators [1179]	$205 - $287	92%
Hartford Auto Insurance [3049]	$205 - $287	92%
Wells Fargo Insurance Services [1139]	$205 - $287	92%
Allied Benefit Systems [1158]	$205 - $287	92%
Josephine County [6030]	$205 - $287	92%
Cco Intercommunity Health Network [5010]	$205 - $287	92%
Imagine 360 [1251]	$205 - $287	92%
Samaritan Health Plan [3043]	$205 - $287	92%
Tribal Health Klamath [1091]	$205 - $287	92%
Liberty Health Plan [1057]	$205 - $287	92%
Geico [6032]	$205 - $287	92%
Tantara [1110]	$205 - $287	92%
Transamerica Gap Supplement [1186]	$205 - $287	92%
United American Ins [1097]	$205 - $287	92%
Deseret Mutual Mhn [1030]	$205 - $287	92%
Covered California [5040]	$205 - $287	92%
First Choice Health PPO [1220]	$205 - $287	92%
Met Life Mva [3045]	$205 - $287	92%
Cco Columbia Pacific [5026]	$205 - $287	92%
Cco Health Share Tuality [5028]	$205 - $287	92%
Central States Idemnity Med Supp [1143]	$205 - $287	92%
Avma Health Group 1St Hlth PPO [1016]	$205 - $287	92%
Principal Life Insurance [1077]	$205 - $287	92%
Plexis Healthcare Systems [1246]	$205 - $287	92%
Mutual of Omaha [1068]	$205 - $287	92%
Cco Eastern Oregon [5023]	$205 - $287	92%
Champva [4001]	$205 - $287	92%
Healthpartners [1192]	$205 - $287	92%
Healthnet Med Supp [1149]	$205 - $287	92%
Aetna	$205 - $287	92%
So Ca Drug Benefit Fund [1133]	$205 - $287	92%
Eob Tpa LLC [1250]	$205 - $287	92%
S&S Health Tpa PPO [1219]	$205 - $287	92%
Dairyland Auto Ins [6010]	$205 - $287	92%
Personify Health [1125]	$205 - $287	92%
Tribal Health Karuk [1090]	$205 - $287	92%
Sbma [1252]	$205 - $287	92%
Teamsters Benefit Trust [1190]	$205 - $287	92%
Us Department of Labor [6036]	$205 - $287	92%
Bs of Ca Promise Health Plan [5039]	$205 - $287	92%
Contra Costa Health [5038]	$205 - $287	92%
Sublimity Insurance [6028]	$205 - $287	92%
Samba [1082]	$205 - $287	92%
Aig Workers Compensation [6000]	$205 - $287	92%
Cigna	$205 - $287	92%
Greater Oregon Behavioral Hlth [5001]	$205 - $287	92%
Asante Moda Health Plan [1245]	$205 - $287	92%
Cco Yamhill Community Care Org [5032]	$205 - $287	92%
Sky Lakes Health Plan [1156]	$205 - $287	92%
Medicare (plans)	$205 - $287	92%
University of Utah Health Plans [1212]	$205 - $287	92%
Claimsbridge Ath01 [1254]	$205 - $287	92%
Combined Insurance [1106]	$205 - $287	92%
Ohp Marion Polk Comm Health Pl [5012]	$205 - $287	92%
Albertson [1004]	$205 - $287	92%
Zurich North America - Claims [6058]	$205 - $287	92%
Plumbers and Pipefitters Union [1083]	$205 - $287	92%
Intermountain Claims [6014]	$205 - $287	92%
Sedgwick Cms [6023]	$205 - $287	92%
Safeco [6021]	$205 - $287	92%
Us Department of Labor [6011]	$205 - $287	92%
Washington Dept of Labor & Ind [6051]	$205 - $287	92%
Masters Mates and Pilots [1063]	$205 - $287	92%
UnitedHealthcare	$205 - $287	92%
Bridgespan Health [1213]	$205 - $287	92%
Allcare Medigap [1162]	$205 - $287	92%
Equitable [1032]	$205 - $287	92%
Providence Health Ph & S Oregon [3036]	$205 - $287	92%
Managed Care Administrators [1128]	$205 - $287	92%
Mailhandlers Benefit [1062]	$205 - $287	92%
Tcc of South Carolina [1135]	$205 - $287	92%
Fra Ins Plans [1035]	$205 - $287	92%
Lucent Health [1187]	$205 - $287	92%
Progressive Auto [6020]	$205 - $287	92%
Cco Health Share OHSU [5041]	$205 - $287	92%
Cco Health Share Oregon [5030]	$205 - $287	92%
Pioneer Life [1075]	$205 - $287	92%
State Comp of Ca [6026]	$205 - $287	92%
Cco Umpqua Health Alliance [5008]	$205 - $287	92%
Allstate Mva [6001]	$205 - $287	92%
Standard Life [1169]	$205 - $287	92%
Mba Benefit Administrators [1253]	$205 - $287	92%
Woodmen Life Supplement [1248]	$205 - $287	92%
Nationwide Ins [3051]	$205 - $287	92%
Kaiser Permanente Hawaii [3050]	$205 - $287	92%
Healthcare Management Admin [1109]	$205 - $287	92%
American Family Auto [3033]	$205 - $287	92%
Cambridge Integrated Service [6004]	$205 - $287	92%
Lifewise Tpm Trust [1058]	$205 - $287	92%
State Mutual Insurance Company [1173]	$205 - $287	92%
Plumbing and Pipefitting Trst [1076]	$205 - $287	92%
Coordinated Benefit Plans [1124]	$205 - $287	92%
State of Oregon [5019]	$205 - $287	92%
Washington National Ins [1099]	$205 - $287	92%
Iec Benefit Administrators [1052]	$205 - $287	92%
Teamsters Food Employers Med Supp [1239]	$205 - $287	92%
Ilwu Pma Welfare Plan [1053]	$205 - $287	92%
Joint Labor Mgmt Retail Trust [1055]	$205 - $287	92%
Kaiser of Washington [1207]	$205 - $287	92%
Blue Shield Out of State PPO [1235]	$205 - $287	92%
International Benefit Administrator [1172]	$205 - $287	92%
Oregon Mutual Insurance Co [6019]	$205 - $287	92%
Argo Group Us Wc Claims [6002]	$205 - $287	92%
Loomis [1060]	$205 - $287	92%
Broadspire [6034]	$205 - $287	92%
Zenith Admin [1104]	$205 - $287	92%
Travelers Insurance Oregon Wc [6035]	$205 - $287	92%
National General Accident Health [1202]	$205 - $287	92%
Phillips Admin Service [1073]	$205 - $287	92%
Screenwise Program [5017]	$205 - $287	92%
UPMC Health Plan [1228]	$205 - $287	92%
Continental Benefits [1196]	$205 - $287	92%
Physicians Mutual Ins [1074]	$205 - $287	92%
Kaiser Covered California [5035]	$205 - $287	92%
Usaa Auto Insurance [3048]	$205 - $287	92%
Farmers Insurance [6012]	$205 - $287	92%
Mba Merchants Benefit Admin [1247]	$205 - $287	92%
Alaska Electrical [1003]	$205 - $287	92%
Nonstop Wellness [3044]	$205 - $287	92%
Construction Teamsters [1123]	$205 - $287	92%
Bristol Hospice [1206]	$205 - $287	92%
Cco Jackson Care Connect [5005]	$205 - $287	92%
Sierra Health and Life [1200]	$205 - $287	92%
Chartis [6006]	$205 - $287	92%
Cannon Cochran Mgmt [6005]	$205 - $287	92%
Teamsters Food Employers Sec [1136]	$205 - $287	92%
Ohp Doctors of Oregon Coast So [5007]	$205 - $287	92%
Providence Health Plan Bh [1205]	$205 - $287	92%
Harrington Benefit Services [1043]	$205 - $287	92%
Zurich Farmers [6029]	$205 - $287	92%
Connecticut General Life [1122]	$205 - $287	92%
Tristar Insurance Group [6042]	$205 - $287	92%
Travelers Insurance Oregon Mva [6050]	$205 - $287	92%
Asante Hospice [1048]	$205 - $287	92%
Medicaid / KanCare	$205 - $287	92%
Boilermaker Natl Hlth and Wlfr [1020]	$205 - $287	92%
Tricare	$205 - $287	92%
Root Insurance Company [6048]	$205 - $287	92%
United Indian Health Services [1211]	$205 - $287	92%
Us Family Health Plan [4007]	$205 - $287	92%
Kaiser Permanente [1056]	$205 - $287	92%
Kemper Auto [3062]	$205 - $287	92%
Providence Hospice [1050]	$205 - $287	92%
Operating Engineers [1071]	$205 - $287	92%
Standard Life and Accident Ins [1167]	$205 - $287	92%
State Farm Health [1084]	$205 - $287	92%
Mvp Select Care [1140]	$205 - $287	92%
Claims Administrator Lucent Health [1188]	$205 - $287	92%
Arkansas Walmart Claims Mgmt [6003]	$205 - $287	92%
Bakery and Confectionery Union [1119]	$205 - $287	92%
Humana	$205 - $287	92%
Auic Org [1118]	$205 - $287	92%
American National [1178]	$205 - $287	92%
Cco Trillium Community Health Plan [5011]	$205 - $287	92%
Crawford and Co [6009]	$205 - $287	92%
Delta Health System [1107]	$205 - $287	92%
Web Tpa [1170]	$205 - $287	92%
Medi Cal [5002]	$205 - $287	92%
Kaiser Permanente [3047]	$205 - $287	92%
Triwest [4006]	$205 - $287	92%
Geha [1038]	$205 - $287	92%
Usaa Ins [1098]	$205 - $287	92%
Ag Specialty Insurance [1242]	$205 - $287	92%
Cco Advanced Health [5027]	$205 - $287	92%
Thrivent Financial [1176]	$205 - $287	92%
Nationwide Worker's Comp [3032]	$205 - $287	92%
Verdegard Administrators LLC [1204]	$205 - $287	92%
Meritain Health [1129]	$205 - $287	92%
Liberty Mutual [6016]	$205 - $287	92%
Starr Indemnity and Liability [1134]	$205 - $287	92%
Enumclaw Property & Casualty [6045]	$205 - $287	92%
Options for Southern Oregon [5022]	$205 - $287	92%
Cco Allcare Health Plan [5013]	$205 - $287	92%
Lumico Life Insurance [1183]	$205 - $287	92%
Healthscope [1126]	$205 - $287	92%
Gpa [1193]	$205 - $287	92%
Transamerica Life Ins [1087]	$205 - $287	92%
Lineco Ins First Health [1059]	$205 - $287	92%
Us Marshals Office [8005]	$205 - $287	92%
National Guardian Life [1208]	$205 - $287	92%
Specialty Risk Solutions [6025]	$205 - $287	92%
Providence Health Assur Med Supp [1079]	$205 - $287	92%
Blue Cross Blue Shield	$205 - $728	92%
Ameriben Solutions [1007]	$205 - $287	92%
Veterans Evaluation Services [4008]	$205 - $287	92%
Western Benefits [1101]	$205 - $287	92%
Oregon State Police [8004]	$205 - $287	92%
Veterans Administration [4004]	$205 - $287	92%
Crime Victims Comp Program [8002]	$205 - $287	92%
Saif [6022]	$205 - $287	92%
Amshield [6057]	$205 - $287	92%
Blue Shield Covered California [1241]	$205 - $287	92%
Jackson County [8003]	$205 - $287	92%
Shasta Administrators [1092]	$205 - $287	92%
Kaiser Northern California HMO [1223]	$205 - $287	92%
Gravie Administrative Services [1249]	$205 - $287	92%
G and G Electric Healthcare Plan [1036]	$205 - $287	92%
Sanford Health Plan [1147]	$205 - $287	92%
Country Companies [6008]	$205 - $287	92%
Medico Insurance Company [1194]	$205 - $287	92%
Farmers Ins Medical [1033]	$205 - $287	92%
Uct Insurance [1094]	$205 - $287	92%
Pai [1130]	$205 - $287	92%
Western Growers Assurance Trust [3053]	$205 - $287	92%
Ebms [1031]	$205 - $287	92%
Esis [6047]	$205 - $287	92%
Western Teamsters Welfare [1103]	$205 - $287	92%
Globe Life and Accident Ins Co [1177]	$205 - $287	92%
Careassist Program/Tpa [1165]	$205 - $287	92%
Ufcw [1095]	$205 - $287	92%
Hartford [6015]	$205 - $287	92%
North America Administrators [1174]	$205 - $287	92%
Cna Workers Compensation [6056]	$205 - $287	92%
Gallagher Bassett [6013]	$205 - $287	92%
Cas Tpa [1210]	$205 - $287	92%
Aither Health Plan [1243]	$205 - $287	92%
Mediplus Troa Claims [1064]	$205 - $287	92%
Rsl Specialty Products Admin [1131]	$205 - $287	92%
Office Workers Com [6018]	$205 - $287	92%
Union Pacific Rr Emp Health [1096]	$205 - $287	92%
Asuris Northwest Health [1117]	$205 - $287	92%
Select Health Plan PPO [1132]	$205 - $287	92%
Alignment Health Plan [7029]	$226	101%
Scan Health Plan [7024]	$226	101%
Cco Cascade Health Alliance [5006]	$226	101%
Pacificsource Med Adv HMO [7035]	$226	101%
Pacificsource Med Adv PPO [7018]	$226	101%
Wellcare Healthnet Med Adv HMO [7022]	$226	101%
Kaiser Med Adv No California HMO [7037]	$226	101%
Kaiser Med Adv So California HMO [7038]	$226	101%
Kaiser Med Adv HMO [7027]	$226	101%
Wellcare Healthnet Med Adv PPO [7023]	$226	101%
Managed Hlth Netwrk Bh Wellcare [7042]	$226	101%
Regence Medadvantage [7017]	$226	101%
Kaiser Med Adv Oregon HMO [7009]	$226	101%
Pyramid Todays Option Premier [7015]	$226	101%
Allcare Advantage [7006]	$226	101%
Samaritan Health Med Adv HMO [7043]	$226	101%
Providence Health Plan [1078]	$226	101%
Kaiser Med Adv Senior Nw [7028]	$226	101%

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 $177.
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 Sky Lakes 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.