CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sharp Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $458
Cash Discount Price: $548
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sharp Memorial Hospital is $458. 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 2.05x the Medicare baseline. Located in 7901 Frost St, San Diego, CA.

Cash / Self-Pay

$548

Average discount available for prompt cash payment at this facility.

Insurance Median

$458

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: $458 (205%)

Cash: $548 (245% of Medicare)

Ins. Median: $458 (205% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 205% of the Medicare baseline (a markup of 105%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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 - $562	N/A
Medicare (plans)	$1 - $511	N/A
Molina	$1 - $584	N/A
Allianz Global Assistance	$46 - $599	21%
Health Net	$102 - $599	46%
Multiplan	$102 - $445	46%
California Health And Wellness	$110 - $599	49%
UnitedHealthcare	$217 - $715	97%
Blue Cross Blue Shield	$248 - $657	111%
Blue Shield	$248 - $584	111%
Interplan	$248 - $725	111%
Cigna	$292 - $511	131%
Indian Health Council	$292	131%
Humana	$350 - $412	156%
Community Health Group	$402 - $445	180%
Kaiser	$402 - $548	180%
County Medical Services	$412 - $496	184%
Medi-Cal	$464 - $715	207%
Epic Americas	$511	228%
San Diego Pace	$548 - $584	245%
Managed Health Network	$584	261%

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 Sharp Memorial 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.