CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Crystal Clinic Orthopaedic Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $2,424
Cash Discount Price: $1,240
vs. Medicare Baseline: 10.83x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Crystal Clinic Orthopaedic Center is $2,424. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,240. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 10.83x the Medicare baseline. Located in 444 North Main Street, Akron, OH.

Cash / Self-Pay

$1,240

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,424

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: $1,240 (554%)

Insurance Median: $2,424 (1083%)

Cash: $1,240 (554% of Medicare)

Ins. Median: $2,424 (1083% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1083% of the Medicare baseline (a markup of 983%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Bc Mcr Adv	$208	93%
Summacare Mcr Adv	$208	93%
UnitedHealthcare	$208 - $3,478	93%
The Health Plan - All Plans	$415	185%
Aultcare - All Plans	$529	236%
Health Oh Network - All Plans	$992	443%
Ohio Health Choice - All Plans	$992	443%
Med Mutual Nas	$1,031	461%
Multiplan - All Plans	$1,091	488%
Healthsmart - All Plans	$1,405	628%
Bc Pathway	$2,067	924%
Cigna	$2,781	1243%
Bc Ohi/Ohii	$2,838	1269%
Summacare Comm - All Other Plans	$3,058	1367%
Med Mutual Medflex	$3,095	1383%
Bc Blue Access	$3,153	1409%
Bc Preferred	$3,153	1409%
Bc Trad - All Other Plans	$3,153	1409%
Med Mutual Aca	$3,520	1573%
Med Mutual Ppo/Pos/Hmo - All Other Plans	$3,868	1729%
Aetna	$3,918	1751%

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 $1,240.
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 Crystal Clinic Orthopaedic Center 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.