CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Franciscan Health Munster

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $130
Cash Discount Price: $42
vs. Medicare Baseline: 0.58x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Franciscan Health Munster is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.58x the Medicare baseline. Located in 701 Superior Ave, Munster, IN.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$130

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: $42 (19%)

Insurance Median: $130 (58%)

Cash: $42 (19% of Medicare)

Ins. Median: $130 (58% 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%
Cigna	$72 - $151	32%
Blue Cross Blue Shield	$86 - $784	38%
Commercial [2001]	$103 - $153	46%
Managed Care [2000]	$103 - $169	46%
Aetna	$111 - $144	50%
Great West Insurance [1055]	$117 - $151	52%
United Medical Resources [1158]	$118 - $169	53%
United Medical Resources [1301]	$118 - $169	53%
UnitedHealthcare	$118 - $169	53%
Medicare (plans)	$232	104%
Workers Comp [1172]	$463	207%
Unicare [1150]	$784	350%

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 $42.
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 Munster 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.