CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Seneca District Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $188
Cash Discount Price: $178
vs. Medicare Baseline: 0.84x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Seneca District Hospital is $188. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.84x the Medicare baseline. Located in 130 Brentwood Drive, Chester, CA.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$188

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: $178 (80%)

Insurance Median: $188 (84%)

Cash: $178 (80% of Medicare)

Ins. Median: $188 (84% 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
Amthem Bc Mcal	$17	8%
Medi-Cal	$17	8%
Ambetter / Centene	$20	9%
Partnership Hp-All Plans	$59	26%
UnitedHealthcare	$60 - $279	27%
Tricare	$111 - $200	50%
Imperial Hp Ma-All Plans	$126 - $225	56%
Blue Cross Blue Shield	$130 - $256	58%
Blue Shield Ipf/Ca Exchange	$142 - $254	63%
Beech Street Corp- All Plans	$151 - $271	67%
Cigna	$151 - $271	67%
Integrated Hp-All Plans	$151 - $271	67%
Interplan Corp- All Plans	$151 - $271	67%
Medincrease- All Plans	$151 - $271	67%
Multiplan- All Plans	$151 - $271	67%
Pacificare - All Plans	$151 - $271	67%
Provider Ntwrk Of America-All Plans	$151 - $271	67%
Alliance- All Plans	$154 - $276	69%
Community Care Network - All Plans	$154 - $276	69%
Coventry- All Plans	$156 - $279	70%
Northern Nevada Health Network- All Plans	$156 - $279	70%
Superior California Ppo - All Plans	$156 - $279	70%
Blue Shield Of Ca- All Other Plans	$157 - $282	70%
Healthnet - All Other Plans	$157 - $282	70%
Three Rivers- All Plans	$157 - $282	70%

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 $178.
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 Seneca District 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.