CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Mary's General Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $371
Cash Discount Price: $258
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Mary's General Hospital is $371. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $258. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.66x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$258

Average discount available for prompt cash payment at this facility.

Insurance Median

$371

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: $258 (115%)

Insurance Median: $371 (166%)

Cash: $258 (115% of Medicare)

Ins. Median: $371 (166% 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
Humana	$207	93%
UnitedHealthcare	$259 - $876	116%
Amerihealth	$259	116%
Wellpoint Amerigroup	$259	116%
Clover Health	$259	116%
Wellcare	$259 - $349	116%
Tricare	$259	116%
Medicare (plans)	$259	116%
Horizon	$259 - $459	116%
Aetna	$259 - $549	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$272	122%
Employer Direct Healthcare	$362	162%
Cigna	$380	170%
Fairprice Healthcare Holdings	$414	185%
Coventry	$518	232%

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 $258.
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 St Mary's General 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.