CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: St Joseph's University Medical Center Inc

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $260
  • Cash Discount Price: $605
  • vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at St Joseph's University Medical Center Inc is $260. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $605. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.16x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$605

Average discount available for prompt cash payment at this facility.

Insurance Median
$260

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: $605 (270%)
Insurance Median: $260 (116%)
Cash: $605 (270% of Medicare)
Ins. Median: $260 (116% 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.

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
Fidelis Care of New Jersey $8 - $273 4%
UnitedHealthcare $8 - $457 4%
Aetna $10 - $531 4%
Ambetter / Centene $10 - $390 4%
Amerihealth $10 - $385 4%
Clover Health $10 - $260 4%
Horizon New Jersey Total Care $10 - $260 4%
Wellpoint $10 - $260 4%
Multiplan $15 - $454 7%
Blue Cross Blue Shield $19 - $741 8%
Consumer Health Network $25 - $544 11%
Private Healthcare Systems $44 - $393 20%
Horizon New Jersey Health $57 - $188 25%
Cigna $67 - $605 30%
Longevity Health Plan $299 134%
Oxford $421 188%
Magnacare $424 190%
Oscar $570 255%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals