CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Mountains Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $51
Cash Discount Price: $30
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Mountains Community Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.23x the Medicare baseline. Located in 29101 Hospital Road, Lake Arrowhead, CA.

Cash / Self-Pay

$30

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $30 (13%)

Insurance Median: $51 (23%)

Cash: $30 (13% of Medicare)

Ins. Median: $51 (23% 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
Kaiser	$12 - $68	5%
Molina	$16 - $48	7%
Aetna	$17 - $74	8%
Cigna	$24 - $74	11%
Usa	$26 - $80	12%
Healthnet	$28 - $85	13%
Phcs	$30 - $90	13%
Blue Shield	$32 - $122	14%
Blue Cross Blue Shield	$75 - $114	34%
Ccn	$192	86%

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 $30.
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 Mountains Community 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.