CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Cape Regional Medical Center Inc

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $201
Cash Discount Price: $260
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Cape Regional Medical Center Inc is $201. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.90x the Medicare baseline. Located in Two Stone Harbor Blvd, Cape May Court House, NJ.

Cash / Self-Pay

$260

Average discount available for prompt cash payment at this facility.

Insurance Median

$201

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: $260 (116%)

Insurance Median: $201 (90%)

Cash: $260 (116% of Medicare)

Ins. Median: $201 (90% 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
Aetna	$26 - $491	12%
Americhoice	$26 - $209	12%
Amerigroup	$28 - $68	13%
Horizon Nj Health	$28 - $68	13%
Cigna	$119 - $282	53%
Blue Cross Blue Shield	$132 - $341	59%
Qualcare	$132 - $302	59%
Horizon Casualty Motor Vehicle	$164 - $408	73%
Horizon Casualty Workers Comp	$164 - $408	73%
Amerihealth	$169 - $420	76%
UnitedHealthcare	$182 - $517	81%
Clover Health	$209	93%
Partners Direct Health	$374	167%

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 $260.
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 Cape Regional Medical Center Inc 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.