CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Tulare

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $311
Cash Discount Price: $128
vs. Medicare Baseline: 1.39x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Tulare is $311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.39x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$311

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: $128 (57%)

Insurance Median: $311 (139%)

Cash: $128 (57% of Medicare)

Ins. Median: $311 (139% 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
Medi-Cal	$17	8%
Dignity Mcal Op Only	$18	8%
Independence Op Only - All Plans	$18	8%
Blue Cross Blue Shield	$22 - $410	10%
Ccipa Medi-Cal - All Plans	$22	10%
Healthnet Medi-Cal	$22	10%
Blue Shield Epn	$256	114%
Blue Shield Mcare	$282	126%
Dignity Mcr Op Only - All Other Plans	$282	126%
Fhcn Pace Mcr Adv - All Plans	$282	126%
Medicare (plans)	$282	126%
Prime Health - All Plans	$282	126%
Tricare	$282	126%
UnitedHealthcare	$282	126%
Cigna	$311	139%
Western Growers - All Plans	$316	141%
Blue Shield-All Other Plans	$356	159%
Prison Hlthcre - All Plans	$360	161%
Cal Forensic Med Grp - All Plans	$366	164%
Aetna	$393	176%
Bright Health - All Plans	$408	182%
Network By Design-All Plans	$437	195%
Hs Interplan-All Plans	$450	201%
Ah Employee Health Plan - All Plans	$507	227%
Incentive Hlth - All Plans	$507	227%
Multiplan - All Plans	$571	255%
Healthnet Hmo/Ppo - All Other Plans	$751	336%

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 $128.
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 Tulare 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.