CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Simi Valley

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $307
Cash Discount Price: $64
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Simi Valley is $307. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.37x the Medicare baseline. Located in 2975 N Sycamore Dr, Simi Valley, CA.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$307

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: $64 (29%)

Insurance Median: $307 (137%)

Cash: $64 (29% of Medicare)

Ins. Median: $307 (137% 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
Gold Coast Mcal - All Plans	$21	9%
Vchcp - All Plans	$161	72%
Hpn Senior Hmo	$168	75%
Hpn - All Other Plans	$202	90%
Kaiser - All Plans	$202	90%
Cigna	$239	107%
Scan Mcr Adv - All Plans	$242	108%
First Health - All Plans	$262	117%
Phcs Ppo - All Plans	$262	117%
Ehn - All Plans	$273	122%
Aetna	$278	124%
Blue Shield Mcare	$282	126%
Facey Medical Mdcare	$282	126%
Medicare (plans)	$282	126%
Tricare	$282	126%
UnitedHealthcare	$282 - $464	126%
Beech Street Ppo - All Plans	$302	135%
Choicecare Ppo - All Plans	$302	135%
Health Net - All Plans	$312	139%
Corvel Corp - All Plans	$322	144%
Interplan Ppo - All Plans	$322	144%
Multiplan Ppo - All Plans	$334	149%
Facey Medical Hmo/Pos - All Other Plans	$338	151%
Western Growers - All Plans	$342	153%
Ahf - All Plans	$343	153%
Hmn Ppo/Epo - All Plans	$343	153%
Trpn Ppo - All Plans	$343	153%
Blue Shield - All Other Plans	$357	160%
Fpn Ppo - All Plans	$363	162%
Bc Exchange	$399	178%
Bc Non Mcs	$446	199%
Ah Employee Health Plan - All Plans	$507	227%
Bc Mcs - All Other Plans	$536	240%
Centivo - All Plans	$634	283%

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 $64.
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 Adventist Health Simi Valley 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.