CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Garfield Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $282
- Cash Discount Price: $447
- vs. Medicare Baseline: 1.26x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Garfield Medical Center is $282. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $447. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.26x the Medicare baseline. Located in 525 N Garfield Ave, Monterey Park, CA.
Cash / Self-Pay
$447
Average discount available for prompt cash payment at this facility.
Insurance Median
$282
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: $447 (200%)
Insurance Median: $282 (126%)
Cash: $447 (200% of Medicare)
Ins. Median: $282 (126% 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 |
|---|---|---|
| Blue Cross Blue Shield | $1 - $568 | N/A |
| Ahmc Healthcare Inc | $12 - $337 | 5% |
| Allied Physicians | $12 - $422 | 5% |
| Beverly Hospital | $12 - $310 | 5% |
| Brand New Day | $12 - $352 | 5% |
| Care 1St Mcl/Gar Cap Reciprocity | $12 | 5% |
| Community Health Plan | $12 | 5% |
| Emanate Health | $12 - $352 | 5% |
| Health Net | $12 - $610 | 5% |
| Healthy Way La | $12 | 5% |
| La Care Health Plan | $12 - $618 | 5% |
| Other Non-Contracting Medi-Cal | $12 | 5% |
| Physicians Healthways Medi-Cal | $12 - $1,124 | 5% |
| Aids Health Foundation | $17 - $277 | 8% |
| Avanti | $17 - $338 | 8% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $17 | 8% |
| Hollywood Presbyterian Medpoint Mcal | $17 | 8% |
| State Of California Medi-Cal | $17 | 8% |
| Physician Healthways Medical Corporation | $19 | 8% |
| Caloptima Direct | $25 | 11% |
| Pacific Independent Physician Association | $29 - $180 | 13% |
| Access Ipa Ancillary | $36 - $337 | 16% |
| Associated Hispanic Phys Of So Cal | $36 - $225 | 16% |
| Care First Health Plan | $36 - $112 | 16% |
| UnitedHealthcare | $36 - $674 | 16% |
| Family Health Alliance | $108 - $337 | 48% |
| Allied Physicians Risk Pool | $126 - $393 | 56% |
| Allied Physicians Risk Pool Agreement | $126 - $393 | 56% |
| Healthnet Medi Cal Cap | $126 - $393 | 56% |
| Pipa Risk Pool Agreement | $126 - $393 | 56% |
| Molina Medical Group | $141 - $438 | 63% |
| Central Health Plan | $144 - $450 | 64% |
| Health Net Foundation Comm/Sr (Family Health Alliance) | $144 - $450 | 64% |
| Health Net Foundation M Cal (Family Health Alliance) | $144 - $450 | 64% |
| Phys Assoc Of San Gab Valley | $144 - $450 | 64% |
| Aetna | $152 - $818 | 68% |
| Allied Physicians Med Grp | $180 - $562 | 80% |
| Blue Shield Of California | $180 - $562 | 80% |
| Pacificare Ppo | $181 | 81% |
| Veterans Administration | $197 | 88% |
| Health Net Comm/Hmo | $199 - $618 | 89% |
| Alhambra Hospital | $217 - $674 | 97% |
| Care 1St Health Plan | $217 - $674 | 97% |
| Employee Health Systems Mg | $217 - $674 | 97% |
| Interplan | $217 - $843 | 97% |
| Pacificare Of California Inc | $246 | 110% |
| First Health Network | $253 - $787 | 113% |
| One Health Plan | $253 - $787 | 113% |
| Fmc Los Angeles Co Epo | $271 - $843 | 121% |
| Apa Aco Inc | $277 | 124% |
| Blue Shield | $277 - $438 | 124% |
| Cms | $277 | 124% |
| Easy Choice Health Plan | $277 | 124% |
| Humana | $277 | 124% |
| Non-Contract Medi-Care | $277 | 124% |
| Pacific Alliance Medical Center Comm/Sr | $277 | 124% |
| Physicians Healthways Medical Corporation | $277 - $1,124 | 124% |
| Advantage Care Ipa | $282 - $1,124 | 126% |
| Cv-19 Hrsa Uninsured Testing And Tx | $282 | 126% |
| La Care Covered Direct | $282 | 126% |
| Scan Health Plan Sr Hmo | $282 | 126% |
| Self-Pay | $282 | 126% |
| Ucla Impact Dept Of Uncology | $282 | 126% |
| Corvel Corporation | $289 - $899 | 129% |
| Alignment Health Plan | $291 | 130% |
| Molina Healthcare | $291 | 130% |
| Molina Healthcare Of California | $291 - $352 | 130% |
| Inter Valley Health Plan | $296 | 132% |
| Americas Health Plan | $307 - $955 | 137% |
| Multiplan | $307 - $955 | 137% |
| National Disaster Medical System | $310 | 139% |
| San Miguel Health Plan | $310 | 139% |
| Health Payors Organization | $325 - $1,012 | 145% |
| Chinatown Service Center Pace | $338 | 151% |
| Ahmc Health Epo | $352 | 157% |
| Knox-Keene Act | $352 | 157% |
| Preferred Health Network | $356 | 159% |
| Athens Administrators | $361 - $375 | 161% |
| Cigna | $361 - $453 | 161% |
| East La Reg Ctr | $361 - $1,124 | 161% |
| Non Contract Commercial | $361 - $1,124 | 161% |
| One Legacy | $361 - $1,124 | 161% |
| Other Non-Contracted Workers Compensation | $361 - $375 | 161% |
| Private Pay | $361 - $1,124 | 161% |
| Health Net Inc | $457 | 204% |