CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Loma Linda University Children's Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $335
Cash Discount Price: $249
vs. Medicare Baseline: 1.50x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Loma Linda University Children's Hospital is $335. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $249. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.50x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$249

Average discount available for prompt cash payment at this facility.

Insurance Median

$335

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: $249 (111%)

Insurance Median: $335 (150%)

Cash: $249 (111% of Medicare)

Ins. Median: $335 (150% 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
Inland Empire Health Plan (Iehp)	$20 - $258	9%
Kaiser Foundation Hospitals	$22 - $394	10%
Adventist Health	$103 - $118	46%
Lluh Dept Of Risk Management	$124 - $142	55%
Epic Health Plan	$206 - $349	92%
Alpha Care Medical Group	$258 - $388	115%
Dignity Health	$258 - $388	115%
UnitedHealthcare	$258 - $536	115%
Upland Medical Group	$258	115%
Vantage Medical Group	$258 - $388	115%
Blue Shield Of California	$279 - $421	125%
Global Benefits Group	$309 - $355	138%
Temecula Valley Physicians Medical Group	$309 - $355	138%
Trivalley Medical Group	$309 - $355	138%
Blue Cross Blue Shield	$316 - $457	141%
Molina Healthcare Of Ca	$326 - $346	146%
Cigna	$330 - $437	148%
Networks By Design	$335 - $384	150%
Aetna	$338 - $388	151%
Multiplan	$412 - $473	184%
Heritage Provider Network	$424	190%
Galaxy Health	$438 - $502	196%
Prime Health Services	$438 - $502	196%

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 $249.
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 Loma Linda University Children's 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.