CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Delano

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $198
Cash Discount Price: $54
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Delano is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.89x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $54 (24%)

Insurance Median: $198 (89%)

Cash: $54 (24% of Medicare)

Ins. Median: $198 (89% 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
Dignty Hlth Mcal Op Only	$17	8%
Kaiser Medi-Cal Ip/Op Only	$17	8%
Medi-Cal	$17	8%
Universal Care Mcal	$17	8%
Healthnet Medi-Cal	$20	9%
Blue Cross Blue Shield	$21 - $235	9%
Kern Health System Mcal	$22	10%
Blue Shield Epn - All Other Plans	$56 - $62	25%
Coventry- All Plans	$152 - $170	68%
Healthnet- All Other Plans	$171 - $190	76%
UnitedHealthcare	$174 - $282	78%
County Of Kern Network - All Plans	$178 - $198	80%
Gem Care- All Plans	$178 - $198	80%
Aetna	$187 - $209	84%
Foundation For Medical Care Of Kern County - All P	$190 - $212	85%
Cigna	$203 - $226	91%
Western Growers - All Plans	$206 - $229	92%
Blue Shield Non-Epn	$262	117%
Bakersfield Fam Med Grp-All Plans	$282	126%
Healthnet Mcr Adv	$282	126%
Kern Mcr Adv Dual Dnsp-All Other Plans	$282	126%
Medicare (plans)	$282 - $451	126%
Tricare	$282	126%
Universal Care Mcr- All Other Plans	$282	126%
Kaiser Comm Ip/Op Only- All Other Plans	$484	216%
Ah Employee Health Plan - All Plans	$507	227%
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 $54.
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 Delano 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.