CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: UCSF Health St. Mary's Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $299
  • Cash Discount Price: $885
  • vs. Medicare Baseline: 1.34x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at UCSF Health St. Mary's Hospital is $299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $885. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.34x the Medicare baseline. Located in 450 Stanyan St, San Francisco, CA.
Cash / Self-Pay
$885

Average discount available for prompt cash payment at this facility.

Insurance Median
$299

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: $885 (396%)
Insurance Median: $299 (134%)
Cash: $885 (396% of Medicare)
Ins. Median: $299 (134% 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.

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
Sfhp $16 7%
Brown Toland $19 - $299 8%
Blue Cross Blue Shield $21 - $368 9%
California Health & Wellness $21 9%
Health Plan San Mateo $21 - $299 9%
Kaiser $21 - $673 9%
Partnership Health Plan $21 9%
Health Net $31 - $299 14%
Aetna $299 134%
Blue Shield Ca $299 - $826 134%
Chinese Community $299 - $484 134%
Connected Care $299 134%
Humana $299 134%
Mhn $299 134%
United $299 - $885 134%
Magellan $531 237%
Healthsmart $620 277%
Multiplan $735 329%
Cigna $788 - $21,649 352%
Kentfield $866 387%
Us Behavioral Health $885 396%
Oscar $980 438%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 450 Stanyan St, San Francisco, CA 94117
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals