CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Holland Community Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $32
Cash Discount Price: $67
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Holland Community Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.14x the Medicare baseline. Located in 602 Michigan Ave, Holland, MI.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $67 (30%)

Insurance Median: $32 (14%)

Cash: $67 (30% of Medicare)

Ins. Median: $32 (14% 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
Meridian Mcaid Profee Only-All Plans	$5	2%
Molina Mcaid - All Plans	$5 - $61	2%
Ph Mcaid	$5 - $61	2%
UnitedHealthcare	$5 - $190	2%
Aetna	$8 - $225	4%
Health Alliance Mcr Adv	$8 - $218	4%
Life Circles-All Plans	$8 - $207	4%
Ph Mcr Adv	$8 - $218	4%
Va Ccn - All Plans	$8 - $218	4%
Longevity Health Plan-All Plans	$9 - $236	4%
First Health-All Plans	$10 - $171	4%
Priority Health - All Other Plans	$11 - $115	5%
Blue Care Network - All Plans	$12	5%
Cigna	$12 - $115	5%
Cofinity -All Plans	$12 - $133	5%
Blue Cross Blue Shield	$13 - $48	6%
Multiplan - All Plans	$15 - $165	7%
Nomi Health - All Plans	$18 - $104	8%
Benefit Source Inc-All Plans	$26 - $171	12%
Usa Managed Care-All Plans	$29 - $171	13%
Integrated Health Plans-All Plans	$30 - $180	13%
Sisco-All Other Plans	$34 - $449	15%
Asr - All Plans	$38 - $517	17%
Health Alliance Ahl - All Other Plans	$38 - $517	17%
Health Alliance Hmo	$38 - $494	17%
Sisco Epi	$449	201%

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 $67.
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 Holland Community Hospital 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.