CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Robert Wood Johnson University Hospital - Somerset

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $425
Cash Discount Price: $135
vs. Medicare Baseline: 1.90x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Robert Wood Johnson University Hospital - Somerset is $425. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.90x the Medicare baseline. Located in 110 Rehill Ave, Somerville, NJ.

Cash / Self-Pay

$135

Average discount available for prompt cash payment at this facility.

Insurance Median

$425

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: $135 (60%)

Insurance Median: $425 (190%)

Cash: $135 (60% of Medicare)

Ins. Median: $425 (190% 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	$56 - $732	25%
UnitedHealthcare	$116 - $430	52%
Fidelis Care	$119 - $222	53%
Aetna	$127 - $664	57%
Clover Health	$222	99%
Humana	$222	99%
Wellpoint	$222	99%
Emblem Health	$389	174%
Cigna	$419 - $561	187%
Wellcare	$442	198%
First Health	$480	215%
Qualcare Inc	$608	272%
Amerihealth	$685	306%

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 $135.
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 Robert Wood Johnson University Hospital - Somerset 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.