CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Howard Memorial

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $199
Cash Discount Price: $105
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Howard Memorial is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.89x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

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: $105 (47%)

Insurance Median: $199 (89%)

Cash: $105 (47% of Medicare)

Ins. Median: $199 (89% 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
Blue Shield Mcare	$9 - $197	4%
Medicare (plans)	$9 - $199	4%
Tricare	$9 - $197	4%
UnitedHealthcare	$9 - $761	4%
Ah Employee Health Plan - All Plans	$10 - $511	4%
Medi-Cal	$12 - $17	5%
Western Growers/Pinnacle - All Plans	$13 - $737	6%
Healthnet - All Plans	$14 - $806	6%
Aetna	$19 - $659	8%
Blue Shield - All Other Plans	$20 - $334	9%
Cigna	$22 - $836	10%
Blue Cross Blue Shield	$23 - $598	10%
Brms - All Plans	$27 - $836	12%
First Health Ppo - All Plans	$279 - $786	125%
Ghn Ppo - All Plans	$279 - $786	125%
Blue Shield Epn	$327	146%

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 $105.
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 Howard Memorial 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.