CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Adventist Health Castle

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $329
Cash Discount Price: $132
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Adventist Health Castle is $329. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.47x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$329

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: $132 (59%)

Insurance Median: $329 (147%)

Cash: $132 (59% of Medicare)

Ins. Median: $329 (147% 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
UnitedHealthcare	$13	6%
Alohacare Quest Mcaid - All Other Plans	$64 - $120	29%
Pacific Admin Ppo - All Plans	$163 - $304	73%
Hwmg/Hmaa - All Plans	$189 - $352	84%
Mdx Hawaii Ppo - All Plans	$205 - $382	92%
Health Alliance - All Plans	$206 - $383	92%
Kfh - All Other Plans	$218 - $407	97%
Uni Health Alliance - All Plans	$240 - $447	107%
First Health Ppo - All Plans	$242 - $450	108%
Medicaid / KanCare	$257 - $479	115%
Kfh Mcr Adv	$259	116%
Medicare (plans)	$259	116%
Ohana Health Plan - All Plans	$264	118%
Devoted Hlth Mcr Adv - All Plans	$272	122%
Hmsa Quest Abd	$393	176%
State Of Hi Nonprofit - All Plans	$450 - $838	201%
Hmsa Quest Non-Abd	$684	306%
Hmsa Hmo	$2,279	1019%
Hmsa Ppo - All Other Plans	$2,279	1019%

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 $132.
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 Castle 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.