CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Valley Children's Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $230
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Valley Children's Hospital is $230. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.03x the Medicare baseline. Located in 9300 Valley Childrens Place, Madera, CA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$230

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%)
Insurance Median: $230 (103%)
Ins. Median: $230 (103% 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.

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
Allcare Ipa $18 - $210 8%
Community Care Ipa $18 - $29 8%
Kaiser $18 - $272 8%
Dignity Ipa_Formerly Img $26 12%
La Salle Ipa $26 12%
Sante Ipa $26 12%
Central Valley Medical Providers Ipa $27 - $210 12%
Sequoia Health Ipa $27 12%
Univseral Healthcare Ipa $27 12%
United Physicians Network Ipa $28 - $210 13%
Adventist $32 14%
Blue Cross Blue Shield $33 - $1,041 15%
Cencal Health $36 16%
Central California Alliance For Health $37 17%
Kern Family Health Care $37 17%
Health Net $147 - $274 66%
Dignity Health Central Coast $208 93%
Community Health $230 103%
Stanislaus Partners In Health $230 103%
Physicians Choice Medical Group $235 105%
Health Plan Of San Joaquin $251 112%
Fowler Packing $260 116%
Dignity (Formerly Managed Care Systems) $264 118%
Kern Legacy $272 122%
Blue Shield $280 - $318 125%
UnitedHealthcare $280 - $298 125%
Aetna $281 126%
First Health Formerly Coventry $310 139%
Bakersfield Family Medical Group $314 140%
Network By Design $325 145%
Community Care Health Plan $335 150%
Health Smart $335 150%
Key Medical Ipa $335 150%
Sutter Health $356 159%
Multiplan $401 179%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 9300 Valley Childrens Place, Madera, CA 93636
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens