CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $218
  • Cash Discount Price: $265
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Munson Healthcare Otsego Memorial Hospital is $218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $265. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.97x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.
Cash / Self-Pay
$265

Average discount available for prompt cash payment at this facility.

Insurance Median
$218

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: $265 (118%)
Insurance Median: $218 (97%)
Cash: $265 (118% of Medicare)
Ins. Median: $218 (97% 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.

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 - $253 4%
Blue Care Network $8 - $218 4%
Hap (Health Alliance Plan) $8 - $250 4%
Humana $8 - $218 4%
Mclaren Health Plan $8 - $262 4%
Medicare (plans) $8 - $218 4%
Michigan Amish Medical Board $8 - $218 4%
Northern Michigan Mennonite Group $8 - $218 4%
Priority Health $8 - $319 4%
UnitedHealthcare $8 - $250 4%
Molina $9 - $236 4%
Cigna $11 - $319 5%
Asr Physicians Care Network $12 - $250 5%
Blue Cross Blue Shield $13 - $195 6%
Nomi Health $13 - $250 6%
Employee Benefit Logistics $14 - $371 6%
Meridian $114 51%
Hospice Of Michigan $187 84%
Munson Hospice $218 - $852 97%
Enterprise Group Planning/Employee Benefit Plan $250 112%
Cofinity $265 118%
Provider Network Of America/Hawaii Mainland Administrative Group Health $265 118%
Three Rivers Provider Network $265 118%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 825 N Center Ave, Gaylord, MI 49735
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals