CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Oak Valley Hospital District

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $126
Cash Discount Price: $146
vs. Medicare Baseline: 0.56x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Oak Valley Hospital District is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.56x the Medicare baseline. Located in 350 S Oak Ave, Oakdale, CA.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $146 (65%)

Insurance Median: $126 (56%)

Cash: $146 (65% of Medicare)

Ins. Median: $126 (56% 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
Blue Cross Blue Shield	$17 - $285	8%
Healthnet Medi-Cal Ip/Op Only	$17	8%
Kaiser Medi-Cal Ip/Op Only	$17	8%
Medi-Cal Ip/Op Only	$17	8%
Hp Of San Joaquin Ip/Op Only-All Plans	$20	9%
Healthnet Comm Op Only Ip/Op Only-All Other Plans	$42 - $187	19%
UnitedHealthcare	$43 - $190	19%
Kaiser Comm Ip/Op Only-All Other Plans	$45 - $197	20%
Cigna	$48 - $212	21%
Blue Shield Epn Ip/Op Only	$50 - $220	22%
Aetna	$61 - $270	27%
Blue Shield/Bcout Ip/Op Only-All Other Plans	$65 - $285	29%
Alignment Op Only Ip/Op Only-All Plans	$282	126%
Humana	$282	126%
Kaiser Mcr Adv Ip/Op Only	$282	126%
Scan Health Plan Ip/Op Only-All Plans	$287	128%
Imperial Health Ip/Op Only-All Plans	$310	139%

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 $146.
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 Oak Valley Hospital District 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.