CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Covenant Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $87
Cash Discount Price: $83
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Covenant Medical Center is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.39x the Medicare baseline. Located in 1447 N Harrison, Saginaw, MI.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $83 (37%)

Insurance Median: $87 (39%)

Cash: $83 (37% of Medicare)

Ins. Median: $87 (39% 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
Aetna	$8 - $350	4%
Blue Cross Blue Shield	$8 - $117	4%
Health Alliance Plan Of Michigan	$8 - $432	4%
Healthy Michigan Mclaren	$8 - $117	4%
Healthy Michigan Meridian	$8 - $117	4%
Healthy Michigan Molina	$8 - $117	4%
Healthy Michigan Priority Health	$8 - $117	4%
Humana	$8 - $357	4%
Mclaren Advantage	$8 - $224	4%
Molina Healthplan	$8 - $224	4%
Physicians Health Plan Advantage/Advantage Plus	$8 - $224	4%
Priority Health	$8 - $262	4%
Blue Care Network	$13 - $224	6%
Mclaren Health Advantage	$15 - $214	7%
Health Advantage Mclaren Employee	$16 - $262	7%
Priority Health E	$16 - $219	7%
Physicians Health Plan	$19 - $262	8%
Meritain Health	$27 - $364	12%
Multiplan	$32 - $428	14%
Cigna	$65 - $262	29%

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 $83.
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 Covenant Medical Center 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.