CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Modoc Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $124
Cash Discount Price: $134
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Modoc Medical Center is $124. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.55x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$124

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: $134 (60%)

Insurance Median: $124 (55%)

Cash: $134 (60% of Medicare)

Ins. Median: $124 (55% 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
Adv Med Mgmt - All Plans	$17	8%
Medi-Cal	$17	8%
Medi-Cal 7/1/24	$17	8%
Partnership Hp - All Plans	$59	26%
Blue Shield Mcr Adv	$73	33%
Blue Shield Va	$73	33%
UnitedHealthcare	$73 - $127	33%
Tricare	$76	34%
Healthnet Mcr Adv	$77	34%
Blue Cross Blue Shield	$110 - $123	49%
Blue Shield Exch	$110	49%
Blue Shield Comm - All Other Plans	$122	55%
Carelon - All Plans	$123	55%
Corvel - All Plans	$126	56%
Aetna	$127	57%
Coventry/First Health - All Plans	$127	57%
Galaxy Health - All Plans	$127	57%
Healthnet Comm - All Other Plans	$127	57%
Hmn - All Plans	$127	57%
Integrated Hp - All Other Plans	$127	57%
Interplan - All Plans	$127	57%
Multiplan - All Other Plans	$127	57%
Superior Ca Ppo - All Plans	$127	57%
Multiplan Wc	$213	95%
Ntwrks By Design Wc - All Plans	$221	99%
Integrated Hp Wc	$224	100%

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 $134.
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 Modoc Medical Center 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.