CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Clearlake

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $252
Cash Discount Price: $222
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Clearlake is $252. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.13x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$222

Average discount available for prompt cash payment at this facility.

Insurance Median

$252

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: $222 (99%)

Insurance Median: $252 (113%)

Cash: $222 (99% of Medicare)

Ins. Median: $252 (113% 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 Cross Blue Shield	$7 - $543	3%
Blue Shield Mcr Adv	$7 - $252	3%
Kaiser Mcr Adv	$7 - $252	3%
Tricare	$7 - $252	3%
UnitedHealthcare	$7 - $1,002	3%
Ah Employee Health Plan - All Plans	$13 - $504	6%
Bc Managed Mcal	$17	8%
Medi-Cal	$17	8%
Aetna	$24 - $897	11%
Western Growers- All Plans	$24 - $901	11%
First Health- All Plans	$26 - $961	12%
Healthnet- All Plans	$26 - $985	12%
Foundation- All Plans	$27 - $1,021	12%
Health Mgmt Network- All Plans	$27 - $1,021	12%
Humana	$27 - $1,021	12%
Phcs- All Plans	$27 - $1,021	12%
Cigna	$29 - $1,081	13%
Interplan- All Plans	$29 - $1,081	13%
Kaiser- All Other Plans	$29 - $1,081	13%
Three Rivers Provider Network- All Plans	$29 - $1,081	13%
Partnership Mcal - All Plans	$53 - $1,982	24%
Blue Shield Epn - All Other Plans	$326	146%
Blue Shield Non-Epn	$333	149%

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 $222.
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 Clearlake 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.