CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Loma Linda University Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $348
Cash Discount Price: $259
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Loma Linda University Medical Center is $348. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $259. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.56x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$259

Average discount available for prompt cash payment at this facility.

Insurance Median

$348

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: $259 (116%)

Insurance Median: $348 (156%)

Cash: $259 (116% of Medicare)

Ins. Median: $348 (156% 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
Inland Empire Health Plan (Iehp)	$20 - $258	9%
Kaiser Foundation Hospitals	$22 - $384	10%
Blue Cross Blue Shield	$105 - $447	47%
Adventist Health	$115 - $258	51%
Lluh Dept Of Risk Management	$115	51%
Epic Health Plan	$230 - $349	103%
Alpha Care Medical Group	$258 - $388	115%
Dignity Health	$258 - $388	115%
UnitedHealthcare	$258 - $536	115%
Upland Medical Group	$258	115%
Vantage Medical Group	$258 - $388	115%
Blue Shield Of California	$268 - $7,837	120%
Prime Health Services	$274 - $489	122%
Riverside University Health System	$284	127%
Global Benefits Group	$345	154%
Temecula Valley Physicians Medical Group	$345	154%
Trivalley Medical Group	$345	154%
Molina Healthcare Of Ca	$346	155%
Aetna	$349 - $27,467	156%
Cigna	$368 - $426	164%
Networks By Design	$374	167%
Multiplan	$412 - $431	184%
Preferred Health Network	$420	188%
Heritage Provider Network	$424	190%
Central Health Plan	$460	206%
Galaxy Health	$489	219%
Health Management Network	$518	232%

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 $259.
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 Loma Linda University Medical Center 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.