CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Ascension Providence Hospital, Southfield and Novi

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $116
Cash Discount Price: $223
vs. Medicare Baseline: 0.52x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Ascension Providence Hospital, Southfield and Novi is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $223. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.52x the Medicare baseline. Located in 16001 W Nine Mile Rd, Southfield, MI.

Cash / Self-Pay

$223

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $223 (100%)

Insurance Median: $116 (52%)

Cash: $223 (100% of Medicare)

Ins. Median: $116 (52% 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
Hap Alliance Health	$20	9%
Hap Hmo Pos	$20	9%
Hap Preferred	$23	10%
Bc Metro Detroit Epo	$26 - $103	12%
Bc Metro Detroit Hmo	$26 - $103	12%
Bcn Local Network Southeast	$26 - $103	12%
Blue Care Network	$26 - $103	12%
Blue Cross Blue Shield	$26 - $103	12%
Medicaid / KanCare	$79 - $199	35%
Molina Health	$79 - $116	35%
Blue Caid Michigan	$116	52%
Harbor Health Mcd	$116	52%
Total Health Care	$116	52%
UnitedHealthcare	$116	52%
Amerihealth Vip Care Mcr	$171 - $197	76%
Aetna	$199	89%
Auto Insurance	$199	89%
Jvhl - Mcr Replacement	$199	89%
Mcr Replacement	$199	89%
Veterans Choice	$199	89%
Humana	$201	90%
Meridian Wellcare	$209	93%
Molina Advantage	$209	93%
Ambetter / Centene	$249	111%
Molina Marketplace	$249	111%
Smart Health	$275	123%

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 $223.
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 Ascension Providence Hospital, Southfield and Novi 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.