CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Watsonville Community Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $354
- Cash Discount Price: $296
- vs. Medicare Baseline: 1.58x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Watsonville Community Hospital is $354. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $296. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.58x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$296
Average discount available for prompt cash payment at this facility.
Insurance Median
$354
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: $296 (132%)
Insurance Median: $354 (158%)
Cash: $296 (132% of Medicare)
Ins. Median: $354 (158% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| California Childrens Srvs | $13 - $18 | 6% |
| Medi-Cal E.R. | $13 - $18 | 6% |
| Healthy Families | $13 - $18 | 6% |
| Medicaid / KanCare | $13 - $18 | 6% |
| Medi-Cal/Eds | $13 - $18 | 6% |
| Ccs/Monterey County | $13 - $18 | 6% |
| Well Path | $13 - $734 | 6% |
| Alliance/Sccho | $18 - $28 | 8% |
| Victim Compensation Plan | $70 - $734 | 31% |
| Medicruz | $70 - $132 | 31% |
| Health Net Pmg HMO | $78 - $460 | 35% |
| Blue Shield HMO | $78 - $147 | 35% |
| UnitedHealthcare | $78 - $440 | 35% |
| Blue Cross Blue Shield | $78 - $654 | 35% |
| Aetna | $78 - $602 | 35% |
| Secure Horizons Dign HMO | $78 - $147 | 35% |
| Great-West/Phcs | $78 - $514 | 35% |
| Pacificare HMO | $78 - $440 | 35% |
| Cigna | $78 - $514 | 35% |
| Sheet Metal Workers | $94 - $654 | 42% |
| Laborers Health & Welfare | $94 - $654 | 42% |
| Robert Kennedy/Ccn | $94 - $654 | 42% |
| Calif Ironworkers Field | $94 - $654 | 42% |
| City of Wats/Pinnacle Clm | $94 - $654 | 42% |
| State Compensation Fund | $94 - $654 | 42% |
| Western Growers Trust/Bc | $94 - $654 | 42% |
| Claims Management Wc | $94 - $654 | 42% |
| Teamsters Benefit Trust | $94 - $654 | 42% |
| Carpenters H&W Trust | $94 - $654 | 42% |
| Pinnacle Claims Tpa/Bc | $94 - $654 | 42% |
| Delta Health Systems | $94 - $654 | 42% |
| Monterey Bay Pub Emp Trst | $94 - $654 | 42% |
| Operating Engineers | $94 - $654 | 42% |
| Western Health Advantage | $194 - $367 | 87% |
| Health Net Smartcare Netw | $233 - $440 | 104% |
| Self Pay | $233 - $440 | 104% |
| Pacificare PPO | $233 - $440 | 104% |
| Health Net of California | $244 - $460 | 109% |
| Health Net Canopycare HMO | $244 - $460 | 109% |
| Health Net Blue and Gold | $244 - $460 | 109% |
| Transwestern | $272 - $587 | 122% |
| Geha (Ccn) | $272 - $587 | 122% |
| Adventist Risk Management | $272 - $587 | 122% |
| First Health | $272 - $587 | 122% |
| Multiplan Inc PPO | $303 - $572 | 135% |
| Private Healthcare System | $303 - $572 | 135% |
| Coastal Healthcare Admin | $330 - $660 | 148% |
| Salinas Valley Mem Hops | $330 - $624 | 148% |
| Prucare Pmg HMO | $388 - $734 | 173% |
| Humana | $388 - $734 | 173% |
| North Calif Bakery Driver | $388 - $734 | 173% |
| Travelers Insurance | $388 - $734 | 173% |
| United Administrative | $388 - $734 | 173% |
| Miscellaneous Auto | $388 - $734 | 173% |
| Bankers Life & Casualty | $388 - $734 | 173% |
| State Farm Ins | $388 - $734 | 173% |
| Allstate | $388 - $734 | 173% |
| Miscellaneous Insurance | $388 - $734 | 173% |
| Physicians Mutual | $388 - $734 | 173% |
| Prucare Pmg POS | $388 - $734 | 173% |
| Apwu Health Plan | $388 - $734 | 173% |
| Wholesale Beer Distributo | $388 - $734 | 173% |
| Zenith National Ins | $388 - $734 | 173% |
| Farmers Insurance | $388 - $734 | 173% |
| Aarp | $388 - $734 | 173% |
| Sutter Health Plus | $388 - $734 | 173% |
| Aaa | $388 - $734 | 173% |