CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Saint Clare's Hospital/ Denville Campus

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $254
Cash Discount Price: $253
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Saint Clare's Hospital/ Denville Campus is $254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $253. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.14x the Medicare baseline. Located in 25 Pocono Road, Denville, NJ.

Cash / Self-Pay

$253

Average discount available for prompt cash payment at this facility.

Insurance Median

$254

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: $253 (113%)

Insurance Median: $254 (114%)

Cash: $253 (113% of Medicare)

Ins. Median: $254 (114% 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
UnitedHealthcare	$82 - $254	37%
Humana	$203	91%
Aetna	$254 - $538	114%
Amerihealth	$254	114%
Clover Health	$254	114%
Horizon	$254 - $528	114%
Medicare (plans)	$254	114%
Tricare	$254	114%
Wellcare	$254 - $343	114%
Wellpoint Amerigroup	$254	114%
Ally-Align (Fka Spartan Health Plan)	$267	119%
Employer Direct Healthcare	$356	159%
Cigna	$392	175%
Fairprice Healthcare Holdings - Fphh	$406	181%
Coventry	$508	227%

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 $253.
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 Saint Clare's Hospital/ Denville Campus 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.