CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: AHMC Anaheim Regional Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $184
- Cash Discount Price: $275
- vs. Medicare Baseline: 0.82x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at AHMC Anaheim Regional Medical Center is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $275. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.82x the Medicare baseline. Located in 1111 W La Palma Avenue, Anaheim, CA.
Cash / Self-Pay
$275
Average discount available for prompt cash payment at this facility.
Insurance Median
$184
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: $275 (123%)
Insurance Median: $184 (82%)
Cash: $275 (123% of Medicare)
Ins. Median: $184 (82% 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 |
|---|---|---|
| Prospect Medical Group | $8 | 4% |
| Monarch Healthcare Medical Group | $10 | 4% |
| Ahmc Reciprocity Agreement | $12 - $533 | 5% |
| Allied Physicians | $12 - $422 | 5% |
| Altamed Health Network | $12 - $277 | 5% |
| Applecare Medical Group | $12 | 5% |
| Beverly Hospital | $12 - $310 | 5% |
| Brand New Day | $12 - $352 | 5% |
| Health Net | $12 | 5% |
| Healthcare Partners | $12 - $277 | 5% |
| Healthy Way La | $12 | 5% |
| Heritage Provider Network | $12 - $380 | 5% |
| Non Contracted Medi-Cal | $12 | 5% |
| Talbert Medical Group | $12 - $22 | 5% |
| Caloptima | $16 - $277 | 7% |
| Monarch Health Plan | $16 - $1,207 | 7% |
| Prospect Health Plan | $16 - $380 | 7% |
| Aids Health Foundation | $17 - $277 | 8% |
| Avanti | $17 - $338 | 8% |
| Emanate Health | $17 - $352 | 8% |
| Health Net Inc | $17 - $1,366 | 8% |
| Healthnet Cal Optima Medi-Cal/Healthy Families | $17 | 8% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $17 | 8% |
| Hollywood Presbyterian Medpoint Mcal | $17 | 8% |
| Kaiser Foundation Hospitals | $17 - $277 | 8% |
| Medi-Cal | $17 | 8% |
| Medical Safety Net Program | $17 | 8% |
| Netcare Life And Health Insurance | $20 - $444 | 9% |
| Advance Clinical Research Institute | $24 - $533 | 11% |
| Memorial Healthcare Ipa | $25 | 11% |
| Medical Acquisition Company | $32 - $711 | 14% |
| Affiliated Doctors Of Orange County | $36 - $800 | 16% |
| Medicare (plans) | $40 - $889 | 18% |
| Aetna | $42 - $925 | 19% |
| Davita Heatlhcare Partners Plan Inc | $43 - $960 | 19% |
| Healthcare Partners Commercial | $43 - $960 | 19% |
| Huntington Memorial Hospital | $43 - $960 | 19% |
| Genesis Healthcare Ipa Ancillary | $48 - $1,067 | 21% |
| Msi/Medical Services For Indigents | $52 | 23% |
| Blue Cross Blue Shield | $55 - $499 | 25% |
| Affiliated Health Fund | $56 - $1,245 | 25% |
| Allnet Preferred Provider | $56 - $1,245 | 25% |
| Care First | $56 - $1,245 | 25% |
| Interplan | $56 - $1,245 | 25% |
| Orange County Preferred Provider Organization | $56 - $1,334 | 25% |
| Private Healthcare Systems | $56 - $1,245 | 25% |
| Capp Care | $60 - $1,334 | 27% |
| Choicecare | $60 - $1,334 | 27% |
| Corvel | $60 - $1,334 | 27% |
| Multiplan Inc | $60 - $1,334 | 27% |
| National Provider Network | $64 - $1,422 | 29% |
| Three Rivers Providers Network | $64 - $1,422 | 29% |
| First Health | $68 - $1,511 | 30% |
| Health Payors Organization | $72 - $1,600 | 32% |
| Angels Baseball Workers Comp | $80 - $318 | 36% |
| Athens Administrators | $80 - $375 | 36% |
| Cigna | $80 - $530 | 36% |
| Marriot Intl | $80 - $375 | 36% |
| Non Contracted Commercial | $80 - $1,778 | 36% |
| Non Contracted Workers Comp | $80 - $375 | 36% |
| Tricare | $80 - $268 | 36% |
| Private Pay Flat Rate | $84 | 38% |
| Blue Shield Of California | $177 - $277 | 79% |
| Veterans Administration | $197 | 88% |
| Alta Los Angeles Hospital | $263 | 118% |
| Alignment Health Plan | $277 | 124% |
| Apa Aco Inc | $277 | 124% |
| California Health Plan | $277 | 124% |
| Central Health Of California | $277 | 124% |
| Healthnet | $277 | 124% |
| Humana | $277 | 124% |
| Pacificare | $277 | 124% |
| Scan Health Plan | $277 | 124% |
| Seoul Medical Group | $277 - $282 | 124% |
| Wellcare | $277 | 124% |
| Cv-19 Hrsa Uninsured Testing And Tx I/P And O/P | $282 | 126% |
| Innovative Integrated Health (Iih)/Orange County Pace | $282 | 126% |
| Self-Pay | $282 | 126% |
| Nchp | $291 | 130% |
| Align Senior Care | $294 | 131% |
| UnitedHealthcare | $343 - $599 | 153% |
| Ahmc Health Self-Insurance Epo | $352 | 157% |
| Knox-Keene Act | $352 | 157% |
| Memorial Healthcare Ipa/Cap/Valuation Rates | $1,403 | 627% |