CMS Price Transparency Data
Breathing treatment (nebulizer)
Facility: Trinity Health Oakland Hospital
Billing Code: 94640 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 94640
- Insurance Median: $187
- Cash Discount Price: $177
- vs. Medicare Baseline: 0.84x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Trinity Health Oakland Hospital is $187. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $177. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.84x the Medicare baseline. Located in 44405 Woodward Ave, Pontiac, MI.
Cash / Self-Pay
$177
Average discount available for prompt cash payment at this facility.
Insurance Median
$187
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: $177 (79%)
Insurance Median: $187 (84%)
Cash: $177 (79% of Medicare)
Ins. Median: $187 (84% 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 |
|---|---|---|
| U Of M Health Plan | $16 | 7% |
| Blue Cross Blue Shield | $17 - $214 | 8% |
| Bcn Domestic | $28 | 13% |
| Blue Benefit Administrators Of Massachusetts | $28 | 13% |
| Blue Care Network | $28 | 13% |
| Blue Distinction Transplant | $28 | 13% |
| Blue Shield - Ca | $28 | 13% |
| Blue Shield - Id (Regence) | $28 | 13% |
| Blue Shield - Ny Highmark Northeastern | $28 | 13% |
| Blue Shield - Ny Highmark Western | $28 | 13% |
| Blue Shield - Pa (Highmark) | $28 | 13% |
| Blue Shield - Wa (Regence) | $28 | 13% |
| Health Choices | $28 - $200 | 13% |
| Kaiser Domestic | $28 | 13% |
| Asr Health Benefits | $43 | 19% |
| Caresource | $43 | 19% |
| Hap | $43 - $198 | 19% |
| Varipro | $43 | 19% |
| Wc Accident Fund | $83 | 37% |
| Wc Advantage | $83 | 37% |
| Wc Aig | $83 | 37% |
| Wc Allied | $83 | 37% |
| Wc Amerisure | $83 | 37% |
| Wc Amtrust | $83 | 37% |
| Wc Asu Risk Mgt | $83 | 37% |
| Wc Berkley Admin | $83 | 37% |
| Wc Broadspire | $83 | 37% |
| Wc Bunch & Associates | $83 | 37% |
| Wc Ccmsi | $83 | 37% |
| Wc Emc Insurance Company | $83 | 37% |
| Wc Esis | $83 | 37% |
| Wc Fcci | $83 | 37% |
| Wc Federated | $83 | 37% |
| Wc Gallagher Bassett | $83 | 37% |
| Wc Genex Care For Ohio | $83 | 37% |
| Wc Guard Insurance Company | $83 | 37% |
| Wc Hartford | $83 | 37% |
| Wc Liberty Mutual | $83 | 37% |
| Wc Meijers | $83 | 37% |
| Wc Michigan | $83 | 37% |
| Wc Mitchell Frankenmuth | $83 | 37% |
| Wc Pma | $83 | 37% |
| Wc Sedgwick | $83 | 37% |
| Wc Sentry | $83 | 37% |
| Wc Travelers | $83 | 37% |
| Wc Tristar | $83 | 37% |
| Wc Walmart | $83 | 37% |
| Wc Zurich | $83 | 37% |
| Aetna | $85 - $214 | 38% |
| Acs Benefit Services | $120 | 54% |
| Allied Benefit Systems | $120 | 54% |
| Claimchoice Adminstrators | $120 | 54% |
| Consociate | $120 | 54% |
| Cypress Benefit Administrators | $120 | 54% |
| Forest County Potawatomi | $120 | 54% |
| Health Smart | $120 | 54% |
| Healthgram | $120 | 54% |
| Healthscope | $120 | 54% |
| Medicaid / KanCare | $120 - $122 | 54% |
| Secureone Preferred United Plans | $120 | 54% |
| Sisco Benefits | $120 | 54% |
| The Health Plan | $120 | 54% |
| Trustmark Small Business Benefits | $120 | 54% |
| Unified Group Services | $120 | 54% |
| Webtpa | $120 | 54% |
| Mclaren Health | $131 - $143 | 59% |
| Carelon Behavioral Health | $136 | 61% |
| Magellan Behavioral Health | $163 | 73% |
| Geha | $170 - $204 | 76% |
| Medical Mutual | $170 | 76% |
| Meritain | $170 | 76% |
| Priority Health | $170 - $189 | 76% |
| 1199 National Benefit Fund | $185 | 83% |
| Allied National Global Care | $185 | 83% |
| Asrm - Reliance Standard Life Insurance | $185 | 83% |
| Christian Care Ministry | $185 | 83% |
| Dean Health | $185 | 83% |
| Fallon Health | $185 | 83% |
| Family Life Insurance Company | $185 | 83% |
| Ghc Scw | $185 | 83% |
| Group Pension Administrators | $185 | 83% |
| International Benefit Administrators | $185 | 83% |
| Lifetime Benefit Solutions | $185 | 83% |
| Manhattan Life | $185 | 83% |
| Medi Share | $185 | 83% |
| Multiplan | $185 | 83% |
| Mvp | $185 | 83% |
| Pai | $185 | 83% |
| Pan-American Life | $185 | 83% |
| Paramount Hmo | $185 | 83% |
| Phcs | $185 | 83% |
| Trinity Health Share | $185 | 83% |
| Health Partners | $198 | 89% |
| Tufts Health Plan | $198 | 89% |
| Access Health | $200 | 89% |
| Acclaim | $200 | 89% |
| Administrative Concepts | $200 | 89% |
| Allegeant | $200 | 89% |
| Ameriben | $200 | 89% |
| American Family | $200 | 89% |
| American Healthcare Alliance | $200 | 89% |
| American National | $200 | 89% |
| American Republic | $200 | 89% |
| Amerihealth | $200 | 89% |
| Aultcare | $200 | 89% |
| Automated Benefit Services | $200 | 89% |
| Auxiant | $200 | 89% |
| Benefit Administrative Systems,Llc | $200 | 89% |
| Boon Chapman | $200 | 89% |
| Cam Administrative Services | $200 | 89% |
| Christian Brother Services | $200 | 89% |
| Christian Brothers Holy Cross | $200 | 89% |
| Comprehensive Benefits | $200 | 89% |
| Continental Life Insurance | $200 | 89% |
| Custom Benefit Administrators | $200 | 89% |
| Employee Benefit Concepts | $200 | 89% |
| Employee Benefit Management | $200 | 89% |
| Enterprise Group Planning | $200 | 89% |
| Freedom Life Insurance Company | $200 | 89% |
| Group Administrators | $200 | 89% |
| Group Marketing Services | $200 | 89% |
| Guardian | $200 | 89% |
| Health America | $200 | 89% |
| Healthcare Management Admin | $200 | 89% |
| Healthez | $200 | 89% |
| Humana | $200 | 89% |
| Insight | $200 | 89% |
| Intercare | $200 | 89% |
| Jfp Benefit Management | $200 | 89% |
| Jp Farley Corporation | $200 | 89% |
| Key Benefit Administrator | $200 | 89% |
| Liberty Union Life Assurance Co | $200 | 89% |
| Lucent Health | $200 | 89% |
| Luminare Health | $200 | 89% |
| Luminare Health (Detroit) | $200 | 89% |
| Magnacare | $200 | 89% |
| Medben | $200 | 89% |
| Medcost | $200 | 89% |
| Mutual Health Services | $200 | 89% |
| Mutual Of Omaha | $200 | 89% |
| Ncas | $200 | 89% |
| Nippon Life Ins | $200 | 89% |
| Nova | $200 | 89% |
| Painters Union Insurance Fund | $200 | 89% |
| Physicians Mutual | $200 | 89% |
| Plumbers Local 98 Insurance Fund | $200 | 89% |
| Prairie States | $200 | 89% |
| Preferred One | $200 | 89% |
| Primary Physician Care | $200 | 89% |
| Professional Benefit Administrators | $200 | 89% |
| Siho Insurance Services | $200 | 89% |
| The Loomis Company | $200 | 89% |
| Unicare | $200 | 89% |
| Us Health And Life | $200 | 89% |
| Valenz | $200 | 89% |
| Western & Southern Financial Group | $200 | 89% |
| Wps | $200 | 89% |
| Cigna | $202 | 90% |
| UnitedHealthcare | $204 - $225 | 91% |
| Coventry | $205 | 92% |
| First Health | $205 | 92% |
| Blue Care Network Advantage | $214 | 96% |
| Medicare (plans) | $214 - $218 | 96% |
| Align Senior Care | $218 | 97% |
| Hospice Advantage | $218 | 97% |
| Prime Health Services | $218 | 97% |
| Cca - Zing Health | $231 | 103% |
| Three Rivers Provider Network | $245 | 110% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $246 | 110% |
| Cmh Detroit Wayne Integrated Health Network | $272 | 122% |
| Cmh Lenawee County | $272 | 122% |
| Cmh Livingston County | $272 | 122% |
| Cmh Misc | $272 | 122% |
| Cmh Monroe County | $272 | 122% |
| Cmh Oakland County | $272 | 122% |
| Cmh Washtenaw County | $272 | 122% |
| Molina Marketplace | $284 | 127% |
| Health Cost Solutions | $338 | 151% |
| Vitalcore | $338 | 151% |
| Wellpath | $338 | 151% |
| Employee Benefit Logistic | $503 | 225% |