CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Charlevoix Area Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $193
Cash Discount Price: $200
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Charlevoix Area Hospital is $193. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.86x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$200

Average discount available for prompt cash payment at this facility.

Insurance Median

$193

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: $200 (89%)

Insurance Median: $193 (86%)

Cash: $200 (89% of Medicare)

Ins. Median: $193 (86% 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
UnitedHealthcare	$7 - $209	3%
Aetna	$8 - $218	4%
Blue Care Network	$8 - $113	4%
Hap (Health Alliance Plan)	$8 - $329	4%
Mclaren Health Plan	$8 - $224	4%
Medicare (plans)	$8 - $113	4%
Michigan Amish Medical Board	$8 - $113	4%
Molina	$8 - $122	4%
Northern Michigan Mennonite Group	$8 - $113	4%
Priority Health	$8 - $241	4%
Cigna	$11 - $241	5%
Asr Physicians Care Network	$12 - $193	5%
Blue Cross Blue Shield	$13 - $223	6%
Nomi Health	$13 - $224	6%
Employee Benefits Logistics	$14 - $193	6%
Hospice Of Michigan	$138 - $145	62%
Meridian	$155	69%
Enterprise Group Planning Employee Benefit Plan	$184 - $193	82%
First Health/Coventry Health/Community Care Network	$184 - $193	82%
Medical Cost Savings Solution	$184 - $193	82%
Provider Network Of America/Hma Group Health	$196 - $307	88%
Three Rivers Provider Network	$196 - $205	88%
Iba Health And Life Assurance Company	$212 - $222	95%
Cofinity	$214 - $224	96%
Preferred Medical Claim Solutions	$218 - $229	97%

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 $200.
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 Charlevoix Area 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.