CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Clovis Community Medical Center
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $21
- Cash Discount Price: $541
- vs. Medicare Baseline: 0.09x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Clovis Community Medical Center is $21. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $541. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.09x the Medicare baseline. Located in 2755 Herndon Ave, Clovis, CA.
Cash / Self-Pay
$541
Average discount available for prompt cash payment at this facility.
Insurance Median
$21
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: $541 (242%)
Insurance Median: $21 (9%)
Cash: $541 (242% of Medicare)
Ins. Median: $21 (9% 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.
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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 |
|---|---|---|
| UnitedHealthcare | $9 - $354 | 4% |
| Sequoia Pace - Peak Tpa | $9 - $282 | 4% |
| Medicare (plans) | $9 - $282 | 4% |
| Blue Shield 65 Plus HMO Ehs | $9 - $282 | 4% |
| Cigna | $9 - $419 | 4% |
| Railroad Part B | $9 - $282 | 4% |
| Cares Act Provider Relief Fund | $9 - $282 | 4% |
| Railroad Part A | $9 - $282 | 4% |
| Meritage Blue Shield 65 Plus | $9 - $282 | 4% |
| Generic Bscphp | $9 - $282 | 4% |
| Blue Shield Saint Agnes | $9 - $282 | 4% |
| Healthnet Sante | $9 - $282 | 4% |
| Medi-Cal Innovative Integrated Health | $9 - $282 | 4% |
| Sante Sub Cap Healthnet Seniority | $9 - $282 | 4% |
| Humana | $9 - $575 | 4% |
| Todays Pyramid | $9 - $282 | 4% |
| Healthnet HMO - Sante | $9 - $282 | 4% |
| Sante-Sub Cap Ma Brand New Day | $9 - $282 | 4% |
| Healthnet Sante - Sub Cap Dual Risk | $9 - $282 | 4% |
| Bscphp - First Choice | $9 - $282 | 4% |
| Healthnet HMO - Dhmso | $9 - $282 | 4% |
| Aetna | $9 - $338 | 4% |
| Blue Shield 65 Plus HMO First Choice | $9 - $282 | 4% |
| Wellcare | $9 - $282 | 4% |
| Generic | $9 - $282 | 4% |
| Meritage Brand New Day | $9 - $282 | 4% |
| Sante-Blue Shield/Sante | $9 - $282 | 4% |
| Healthnet HMO - La Salle | $9 - $282 | 4% |
| Blue Cross Blue Shield | $9 - $430 | 4% |
| Meritage Healthnet HMO | $9 - $282 | 4% |
| Healthnet Sante Dual Risk | $9 - $282 | 4% |
| Railroad Part A & B | $9 - $282 | 4% |
| Gemcare HMO | $9 - $282 | 4% |
| Sante | $9 - $282 | 4% |
| Advantek Table Mountain Rancheria Tribal Member | $9 - $282 | 4% |
| Blue Shield | $9 - $385 | 4% |
| Victims of Crime | $9 - $282 | 4% |
| Healthnet HMO - Cvmp/Medpro | $9 - $282 | 4% |
| Well Path (Cfmg) | $9 - $744 | 4% |
| Hartford Life Supplement | $9 - $282 | 4% |
| Care1St HMO - Ehs | $9 - $282 | 4% |
| Us Marshal | $9 - $282 | 4% |
| Blue Shield Hmo-Cvmp/Medpro | $9 - $282 | 4% |
| Blue Shield Sante | $9 - $282 | 4% |
| Scan Health Plan | $9 - $282 | 4% |
| Sante Sub Cap-Blue Shield/Sante | $9 - $282 | 4% |
| Sante-Healthnet Seniority | $9 - $282 | 4% |
| Bscphp - Dhmso | $9 - $282 | 4% |
| Blue Shield Promise - Imperial | $9 - $282 | 4% |
| Brand New Day | $9 - $282 | 4% |
| Generic Victims of Crime | $9 - $282 | 4% |
| Bscphp HMO - First Choice | $9 - $282 | 4% |
| Alignment Health Plan | $10 - $310 | 4% |
| Innovative Integrated Health Community Plans HMO | $10 - $310 | 4% |
| Champion Health Plan of California Ma | $10 - $310 | 4% |
| Imperial Health Plan HMO | $11 - $324 | 5% |
| Fresno County Funded Specialty Care | $12 | 5% |
| Santa Clara Family Health Plan - Valley Health | $12 | 5% |
| Medi-Cal Alameda Alliance for Health | $12 | 5% |
| Ccs Tulare | $12 | 5% |
| Ccs Fresno | $12 | 5% |
| Ccs Kings | $12 | 5% |
| Ccs Mariposa | $12 | 5% |
| Ccs Madera/Sacramento | $12 | 5% |
| Cal Caloptima | $12 | 5% |
| Generic Ccs Other Counties | $12 | 5% |
| Medi-Cal Community Health Group | $12 | 5% |
| Medi-Cal La Care Health | $12 | 5% |
| Correctcare Integrated Health | $12 - $366 | 5% |
| Medi-Cal Partnership Health Plan of Ca | $12 | 5% |
| Medi-Cal Blue Shield Promise Health | $12 | 5% |
| Gold Coast Medi-Cal | $12 | 5% |
| Medi-Cal Contra Costa Health Plan | $12 | 5% |
| Medi-Cal Inland Empire Health | $12 | 5% |
| Ccs Kern | $12 | 5% |
| Ccs Stanislaus | $12 | 5% |
| Genetically Handicapped Person | $12 | 5% |
| Medi-Cal Cencal Health | $12 | 5% |
| Ccs Merced | $12 | 5% |
| Generic Care Out of County | $12 | 5% |
| Chdp | $12 | 5% |
| Medi-Cal Molina | $12 | 5% |
| Medi-Cal Health Plan of San Mateo | $12 | 5% |
| Medi-Cal Kern Family Health | $12 | 5% |
| Santa Clara Family Health Plan - Premier Health | $12 | 5% |
| Medi-Cal California Health & Wellness Plan | $12 | 5% |
| San Francisco Health Plan Medi-Cal | $12 | 5% |
| Sequoia Pace | $18 | 8% |
| Health Plan of San Joaquin | $18 | 8% |
| Coalinga State Hospital | $19 - $563 | 8% |
| Adventist -McL Calviva Sub Cap | $19 | 8% |
| Naphcare Inc-Mendota | $20 - $606 | 9% |
| Healthnet | $23 - $397 | 10% |
| Central Valley Medical Providers | $169 - $473 | 76% |
| Community Care | $172 | 77% |
| Kaiser | $224 | 100% |
| Employer 90/40 | $270 | 121% |
| Nx Health Network PPO | $372 | 166% |
| Central Ca Indian Health | $372 | 166% |
| Healthsmart | $460 - $541 | 206% |
| Coventry Health Care (First Health Network) | $507 | 227% |
| Network By Design | $507 | 227% |
| PHCS | $575 | 257% |
| Generic Multiplan | $575 | 257% |