CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Franciscan Health Michigan City

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $174
Cash Discount Price: $58
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Franciscan Health Michigan City is $174. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.78x the Medicare baseline. Located in 3500 Franciscan Way, Michigan City, IN.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$174

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: $58 (26%)

Insurance Median: $174 (78%)

Cash: $58 (26% of Medicare)

Ins. Median: $174 (78% 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
Mdwise [1175]	$25	11%
Medicaid / KanCare	$25 - $30	11%
Managed Health Services [1302]	$26	12%
Aetna	$70 - $259	31%
Managed Care [2000]	$70 - $310	31%
Cigna	$73 - $242	33%
Blue Cross Blue Shield	$86 - $799	38%
Commercial [2001]	$102 - $345	46%
United Medical Resources [1158]	$102 - $207	46%
United Medical Resources [1301]	$102 - $230	46%
UnitedHealthcare	$102 - $230	46%
Great West Insurance [1055]	$103 - $208	46%
Medicare (plans)	$232	104%
Workers Comp [1172]	$463	207%
Unicare [1150]	$799	357%

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 $58.
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 Franciscan Health Michigan City 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.