CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Menifee Global Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $183
- Cash Discount Price: $171
- vs. Medicare Baseline: 0.82x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Menifee Global Medical Center is $183. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $171. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.82x the Medicare baseline. Located in 28400 McCall Boulevard, Sun City, CA.
Cash / Self-Pay
$171
Average discount available for prompt cash payment at this facility.
Insurance Median
$183
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: $171 (76%)
Insurance Median: $183 (82%)
Cash: $171 (76% of Medicare)
Ins. Median: $183 (82% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $8 - $262 | 4% |
| Health Net Enhanced Ppo | $13 - $392 | 6% |
| Lasalle Medical Assoc (Ancillary) Mcal Hmo | $14 | 6% |
| Health Net Medi-Cal | $17 | 8% |
| Ic | $17 - $280 | 8% |
| Kaiser Medi-Cal | $17 | 8% |
| Prospect Health Plan Mcal Hmo | $17 | 8% |
| Blue Cross Blue Shield | $18 | 8% |
| Molina Medi-Cal | $20 | 9% |
| Altamed Mcal Hmo | $23 | 10% |
| Altamed Mcal/Pace | $23 | 10% |
| Hpn Mcal | $23 | 10% |
| Iehp Medi-Cal | $25 | 11% |
| Velocity | $72 - $493 | 32% |
| First Health Commercial | $83 - $96 | 37% |
| Aetna | $101 - $280 | 45% |
| Primecare Commercial | $103 - $119 | 46% |
| Multiplan Ppo | $111 - $128 | 50% |
| Multiplan Wcomp | $111 - $128 | 50% |
| Cigna | $127 - $315 | 57% |
| Pnoa-Provider Network Of America | $127 - $146 | 57% |
| Prime Health Services Commercial | $127 - $146 | 57% |
| Altamed Comm Hmo (Ancillary) | $159 - $280 | 71% |
| Ava Hospice | $159 - $183 | 71% |
| Coventry | $159 - $183 | 71% |
| Kaiser Commercial | $159 - $183 | 71% |
| Living Waters Hospice | $159 - $183 | 71% |
| Managed Health Network | $159 - $183 | 71% |
| Other Insurance Loa | $159 - $183 | 71% |
| Pacific Valley Hospice | $159 - $183 | 71% |
| Prime Health Services Wcomp | $159 - $183 | 71% |
| Private Pay | $159 - $183 | 71% |
| Silverado Hospice | $159 - $183 | 71% |
| Three Rivers Wcomp | $159 - $183 | 71% |
| Vna Hospice | $159 - $183 | 71% |
| Workers Comp Non-Contracted | $159 - $183 | 71% |
| Choice Physicians Network | $175 | 78% |
| Molina Covered Ca | $274 | 122% |
| Altamed Health Services Senior | $280 | 125% |
| Altamed Sr/Pace | $280 | 125% |
| Blue Shield Senior | $280 | 125% |
| Central Health Plan Senior | $280 | 125% |
| Clever Care Health Plan Sr | $280 | 125% |
| For Your Benefit Senior | $280 | 125% |
| Guidant Health Plan Senior | $280 | 125% |
| Health Net Senior | $280 | 125% |
| Hpn Senior | $280 | 125% |
| Humana | $280 | 125% |
| Kaiser Senior | $280 | 125% |
| Lasalle Medical Assoc (Ancillary) Senior | $280 | 125% |
| Managed Health Network Sr | $280 | 125% |
| Medicare (plans) | $280 | 125% |
| Neighborhood Healthcare Pace | $280 | 125% |
| Primecare Senior | $280 | 125% |
| Prospect Health Plan Sr Hmo | $280 | 125% |
| Scan Senior | $280 | 125% |
| Sr Capitation | $280 | 125% |
| UnitedHealthcare | $280 - $370 | 125% |
| Veterans Administration | $280 | 125% |
| Imperial Health Plan Of Ca | $282 | 126% |
| Lasalle Medical Assoc (Ancillary) Commercial | $282 | 126% |
| Point Comfort Underwriters | $282 | 126% |
| Self Pay/Ab774/Charity Discount | $282 | 126% |
| Align Senior Care | $314 | 140% |
| Welbehealth Sr/Pace | $314 | 140% |
| Prime Health Services Senior | $322 | 144% |
| Iehp Covered Ca | $350 | 156% |
| Prospect Health Plan Comm Hmo | $378 | 169% |
| Hpn Commercial/Covered Ca | $392 | 175% |
| Health Net Comm | $420 | 188% |
| Three Rivers Network | $493 | 220% |
| Blue Shield Epn | $788 | 352% |
| Blue Shield Commercial | $928 | 415% |