CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: San Gabriel Valley Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $131
- Cash Discount Price: $41
- vs. Medicare Baseline: 0.59x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at San Gabriel Valley Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.59x the Medicare baseline. Located in 438 W Las Tunas Drive, San Gabriel, CA.
Cash / Self-Pay
$41
Average discount available for prompt cash payment at this facility.
Insurance Median
$131
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: $41 (18%)
Insurance Median: $131 (59%)
Cash: $41 (18% of Medicare)
Ins. Median: $131 (59% 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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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 | $1 - $1,206 | N/A |
| Ahmc Medi-Cal Reciprocity | $12 | 5% |
| Allied Physicians | $12 - $422 | 5% |
| Altamed Health Network | $12 - $277 | 5% |
| Beverly Hospital | $12 - $310 | 5% |
| Brand New Day | $12 - $352 | 5% |
| Emanate Health | $12 - $352 | 5% |
| Healthnet Medi-Cal Non-Contract | $12 | 5% |
| Non Contracting Medi Cal | $12 | 5% |
| La Care Health Plan | $13 - $282 | 6% |
| Care 1St Health Plan | $16 - $94 | 7% |
| Aids Healthcare Foundation | $17 - $282 | 8% |
| Avanti | $17 - $338 | 8% |
| Healthy Way La | $17 | 8% |
| Hollywood Presbyterian Adv Med Mcal | $17 | 8% |
| Hollywood Presbyterian Medpoint Mcal | $17 | 8% |
| Medicaid / KanCare | $17 | 8% |
| Physicians Healthways | $17 - $282 | 8% |
| Ahmc Reciprocity | $39 - $43 | 17% |
| Private Pay | $44 | 20% |
| Alignment Healthplan | $46 - $50 | 21% |
| Clever Care | $46 - $50 | 21% |
| Molina Healthcare Of California | $51 - $296 | 23% |
| Pacific Independent Physician Associates | $52 - $58 | 23% |
| Health Net | $63 - $789 | 28% |
| Facey Medical | $66 - $72 | 30% |
| Aetna | $68 - $408 | 30% |
| Central Health Plan | $79 - $277 | 35% |
| Community Care Network | $85 - $94 | 38% |
| Choicecare Network | $92 - $101 | 41% |
| Private Healthcare Systems (Phcs) | $92 - $101 | 41% |
| Affiliated Health Fund | $98 - $108 | 44% |
| Beech Street | $105 - $144 | 47% |
| Pacificare Of California | $114 - $277 | 51% |
| Multiplan | $118 - $130 | 53% |
| Ppo Next | $118 - $130 | 53% |
| Athens Administrators | $131 - $144 | 59% |
| Cigna | $131 - $144 | 59% |
| Managed Health Network | $131 - $144 | 59% |
| Medi-Cal Sub Acute | $131 - $144 | 59% |
| One Legacy | $131 - $144 | 59% |
| Other Non Contracted Commercial | $131 - $144 | 59% |
| Other Non Contracting Workers Comp | $131 - $144 | 59% |
| Us Behavioral Health Plan | $131 - $144 | 59% |
| Veterans Administration | $197 | 88% |
| UnitedHealthcare | $203 - $299 | 91% |
| Alignment Health Plan | $277 | 124% |
| Apa/Aco Inc | $277 | 124% |
| Blue Shield Of California | $277 - $438 | 124% |
| Health Net Inc | $277 - $658 | 124% |
| Humana | $277 | 124% |
| Medicare (plans) | $277 - $291 | 124% |
| Pacific Alliance Medical Center | $277 | 124% |
| Providence Health Network | $277 | 124% |
| Tricare | $277 | 124% |
| Wellcare | $277 | 124% |
| Cv-19 Hrsa Uninsured Testing And Tx | $282 | 126% |
| Inter Valley Health Plan | $282 | 126% |
| Self-Pay | $282 | 126% |
| St Vincent Medical Center/Psych | $282 | 126% |
| Chinatown Service Center Pace | $333 | 149% |
| Ahmc Health Self-Insurance Epo | $352 | 157% |
| Knox-Keene Act | $352 | 157% |