CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Grossmont Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $445
Cash Discount Price: $548
vs. Medicare Baseline: 1.99x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Grossmont Hospital is $445. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $548. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.99x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$548

Average discount available for prompt cash payment at this facility.

Insurance Median

$445

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: $548 (245%)

Insurance Median: $445 (199%)

Cash: $548 (245% of Medicare)

Ins. Median: $445 (199% 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
Aetna	$1 - $657	N/A
Blue Shield	$1 - $584	N/A
Cigna	$1 - $484	N/A
County Medical Services	$1 - $599	N/A
Epic Americas	$1 - $562	N/A
Health Net	$1 - $599	N/A
Medi-Cal	$1 - $562	N/A
Medicare (plans)	$1 - $466	N/A
San Diego Pace	$1 - $489	N/A
UnitedHealthcare	$1 - $599	N/A
Community Health Group	$46 - $715	21%
Humana	$46 - $657	21%
Kaiser	$46 - $584	21%
Indian Health Council	$110 - $599	49%
Multiplan	$110 - $584	49%
Blue Cross Blue Shield	$204 - $599	91%
Molina	$223 - $599	100%
Allianz Global Assistance	$248 - $584	111%
California Health And Wellness	$338 - $548	151%
Managed Health Network	$350 - $548	156%
Interplan	$466 - $599	208%

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 $548.
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 Grossmont 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.