CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Community Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $382
Cash Discount Price: $133
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Community Medical Center is $382. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.71x the Medicare baseline. Located in 99 Rt 37 West, Toms River, NJ.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$382

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: $133 (59%)

Insurance Median: $382 (171%)

Cash: $133 (59% of Medicare)

Ins. Median: $382 (171% 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
Blue Cross Blue Shield	$63 - $586	28%
UnitedHealthcare	$80 - $383	36%
Fidelis Care	$81 - $222	36%
Aetna	$87 - $353	39%
Clover Health	$222	99%
Humana	$222	99%
Wellpoint	$222 - $365	99%
Cigna	$381 - $510	170%
First Health	$385	172%
Emblem Health	$389	174%
Qualcare Inc	$428 - $456	191%
Wellcare	$442	198%
Amerihealth	$478	214%

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 $133.
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 Community Medical 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.