CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Promedica Monroe Regional Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $120
Cash Discount Price: $111
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Promedica Monroe Regional Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.54x the Medicare baseline. Located in 718 N Macomb St, Monroe, MI.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $111 (50%)

Insurance Median: $120 (54%)

Cash: $111 (50% of Medicare)

Ins. Median: $120 (54% 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 - $217	4%
Blue Cross Blue Shield	$8 - $217	4%
Health Alliance Plan	$8 - $221	4%
Humana	$8 - $224	4%
Paramount Healthcare Inc	$8 - $212	4%
Priority Health	$8 - $217	4%
Amerihealth	$45	20%
Frontpath	$99	44%
Encore Health Network	$120	54%
Health Ohio Network, Llc	$120	54%
Meridian	$120	54%
Cofinity	$122	55%
Molina Healthcare Of Michigan	$130	58%
UnitedHealthcare	$132 - $139	59%
Multiplan	$154	69%
Veterans Affairs	$221	99%

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 $111.
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 Promedica Monroe Regional 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.