CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Sherman Oaks Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $280
Cash Discount Price: $280
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Sherman Oaks Hospital is $280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $280. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.25x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$280

Average discount available for prompt cash payment at this facility.

Insurance Median

$280

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: $280 (125%)

Insurance Median: $280 (125%)

Cash: $280 (125% of Medicare)

Ins. Median: $280 (125% 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
Aids Healthcare Foundation	$17 - $286	8%
Blue Shield Of Promise	$17	8%
Health Net Of Ca	$17 - $409	8%
L.A Care Health Plan	$17 - $280	8%
Molina	$17 - $280	8%
Traditional Medi-Cal	$17	8%
Blue Cross Blue Shield	$18	8%
Alignment	$280	125%
Blue Shield Of Ca, Va	$280	125%
Elite Health Plan	$280	125%
Imperial Health Plan	$280	125%
Managed Health Network	$280	125%
Medicare (plans)	$280	125%
Renal Payer Solutions	$280	125%
Tricare	$280	125%
Usa Senior Care Network	$280	125%
Brand New Day	$283 - $420	126%
Corvel	$320	143%
Zelis Healthcare	$320	143%
Americas Choice Provider Network	$326	146%
Multiplan	$326	146%
Prime Health Services	$326	146%
Three Rivers	$326	146%
Healthsmart Preferred Network	$330	148%
Provider Select	$333	149%
Provider Network Of America	$336	150%
Aetna	$358	160%
Ca Foundation For Medical Center	$369	165%
Worker Comp	$369	165%
Employer Direct Healthcare	$392	175%
Naphcare	$434	194%

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 $280.
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 Sherman Oaks Hospital 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.