CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: The University Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $379
Cash Discount Price: $267
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at The University Hospital is $379. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $267. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.69x the Medicare baseline. Located in 150 Bergen St, Newark, NJ.

Cash / Self-Pay

$267

Average discount available for prompt cash payment at this facility.

Insurance Median

$379

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: $267 (119%)

Insurance Median: $379 (169%)

Cash: $267 (119% of Medicare)

Ins. Median: $379 (169% 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
Amerihealth	$16 - $232	7%
Horizon	$97 - $465	43%
Aetna	$195 - $379	87%
Fidelis	$195 - $232	87%
UnitedHealthcare	$195 - $232	87%
Wellpoint	$199	89%
Clover Health	$232	104%
First Health	$465	208%
Americare	$498	223%
Qualcare	$498	223%
Correctional Medical Services	$531	237%
Multiplan	$531	237%
First Trenton	$598	267%
Managed Care Inc	$598	267%
Consumer Health Network	$631	282%
Three Rivers	$631	282%

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 $267.
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 The University Hospital 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.