CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: University of Michigan Health - West

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $85
Cash Discount Price: $39
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at University of Michigan Health - West is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.38x the Medicare baseline. Located in 5900 Byron Center Avenue, Sw, Wyoming, MI.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $39 (17%)

Insurance Median: $85 (38%)

Cash: $39 (17% of Medicare)

Ins. Median: $85 (38% 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
Medicaid / KanCare	$16 - $120	7%
Web Tpa	$29 - $56	13%
Aetna	$45 - $85	20%
Alliance Health & Life Ppo	$45 - $85	20%
Asr Physicians	$45 - $85	20%
Hap	$45 - $85	20%
Golden Rule Ins	$48 - $92	21%
Medica	$48 - $92	21%
Student Ins/Mega Life	$48 - $92	21%
UnitedHealthcare	$48 - $92	21%
Humana	$50 - $224	22%
Asr Cofinity	$56 - $106	25%
Cofinity Commercial	$56 - $106	25%
Cofinity Weyco	$56 - $106	25%
Core Source	$56 - $106	25%
Epoch Group	$56 - $106	25%
Health Partners	$56 - $106	25%
Hlthcomp Admin	$56 - $106	25%
Mid America	$56 - $106	25%
Molina Healthcare Of Mi	$120	54%
Care Resources	$201	90%
Insight Metro Care	$224	100%
Medicare (plans)	$224	100%
Molina Marketplace Commercial	$224	100%
Priority Health	$329	147%

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 $39.
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 University of Michigan Health - West 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.