CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Community Memorial Hospital - Ventura

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $258
Cash Discount Price: $315
vs. Medicare Baseline: 1.15x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Community Memorial Hospital - Ventura is $258. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $315. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.15x the Medicare baseline. Located in 147 North Brent Street, Ventura, CA.

Cash / Self-Pay

$315

Average discount available for prompt cash payment at this facility.

Insurance Median

$258

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: $315 (141%)

Insurance Median: $258 (115%)

Cash: $315 (141% of Medicare)

Ins. Median: $258 (115% 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
Seaview	$9	4%
Valley Care	$12 - $172	5%
Medi-Cal	$17	8%
Non Contracted	$17 - $258	8%
Gold Coast Health Plan	$25 - $241	11%
Medicaid / KanCare	$25 - $241	11%
Ventura County Health Care Plan	$98 - $172	44%
Multiplan	$234 - $413	105%
Tricare	$246	110%
Aetna	$258 - $672	115%
Blue Cross Blue Shield	$258 - $785	115%
California Workers Compensation	$258	115%
Medicare (plans)	$258 - $264	115%
Wellcare Of California	$258	115%
Alignment Health Plan	$264	118%
Humana	$264	118%
Scan Health Plan	$264	118%
UnitedHealthcare	$264 - $1,163	118%
Cigna	$290	130%
Health Net Commercial	$390 - $688	174%
Kaiser Commercial	$528	236%
Blue Shield Epn	$578	258%
Blue Shield Commercial	$626	280%

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 $315.
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 Community Memorial Hospital - Ventura 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.