CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Twin Cities

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $383
Cash Discount Price: $46
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Twin Cities is $383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.71x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$383

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: $46 (21%)

Insurance Median: $383 (171%)

Cash: $46 (21% of Medicare)

Ins. Median: $383 (171% 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	$226	101%
Blue Shield Epn	$244	109%
Blue Shield Hmo/Pos	$280	125%
Aetna	$281 - $425	126%
Cencal Mcr Adv - All Other Plans	$281	126%
Tricare	$281	126%
UnitedHealthcare	$281 - $1,645	126%
Blue Shield Epo/Ppo - All Other Plans	$329	147%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$365	163%
Chn-Community Hlth Ntwrk-All Plans	$365	163%
Nbd-Ntwrks By Design Exlus-All Other Plans	$383	171%
Nbd-Ntwrks By Design Non-Exlus	$383	171%
Ah Employee Health Plan - All Plans	$506	226%
Pacific Health Alliance-All Plans	$598	267%
Medi-Cal	$664	297%
Cencal Mcal	$757	338%
Blue Shield Promise Mcal	$798	357%
Ccah-Centrl Ca Allince Mcal-All Plans	$863	386%
Coalinga-All Plans	$863	386%

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 $46.
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 Twin Cities 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.