CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Sierra Vista

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $356
Cash Discount Price: $33
vs. Medicare Baseline: 1.59x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Sierra Vista is $356. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.59x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$33

Average discount available for prompt cash payment at this facility.

Insurance Median

$356

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: $33 (15%)

Insurance Median: $356 (159%)

Cash: $33 (15% of Medicare)

Ins. Median: $356 (159% 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
Hpn-Heritage Prov Ntwrk-All Plans	$108 - $131	48%
Blue Shield Epn	$149 - $273	67%
Nbd-Ntwrks By Design Exclus-All Other Plans	$184 - $222	82%
Nbd-Ntwrks By Design Non-Exclus	$184 - $222	82%
Blue Shield Hmo/Pos	$186 - $344	83%
Aetna	$198 - $281	89%
Blue Shield Epo/Ppo-All Other Plans	$205 - $373	92%
Cencal Mcr Adv - All Other Plans	$281	126%
Tricare	$281	126%
UnitedHealthcare	$281 - $1,647	126%
Medi-Cal	$319 - $385	143%
Cencal Mcal	$364 - $439	163%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$365	163%
Blue Shield Promise Mcal	$383 - $463	171%
Ccah-Centrl Ca Allince Mcal-All Plans	$415 - $500	185%
Coalinga-All Plans	$415 - $500	185%
Ah Employee Health Plan - All Plans	$506	226%

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 $33.
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 Sierra Vista 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.