CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Atlantic Rehabilitation Institute, LLC

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $104
Cash Discount Price: $104
vs. Medicare Baseline: 0.46x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Atlantic Rehabilitation Institute, LLC is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.46x the Medicare baseline. Located in 200 Madison Ave, Madison, NJ.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $104 (46%)

Insurance Median: $104 (46%)

Cash: $104 (46% of Medicare)

Ins. Median: $104 (46% 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
Aetna	$83 - $200	37%
All Savers Cpd	$83 - $200	37%
Ama Insurance Msg	$83 - $200	37%
Ambetter / Centene	$83 - $200	37%
Amerigroup Mgg (Wellpoint As Of 5/1/24)	$83 - $200	37%
Amerihealth Cpd	$83 - $200	37%
Amerihealth Mgg	$83 - $200	37%
Blue Cross Blue Shield	$83 - $200	37%
Braven Health Cpd	$83 - $200	37%
Braven Health Mgd	$83 - $200	37%
Cigna	$83 - $200	37%
Claim Doc Llc Cpd	$83 - $200	37%
First Managed Care Wc Cpd	$83 - $200	37%
Gateway Mgg	$83 - $200	37%
Medicaid / KanCare	$83 - $200	37%
Oscar Health Cpd	$83 - $200	37%
Oxford Health Plan Cpd	$83 - $200	37%
Oxford Mgg	$83 - $200	37%
Qualcare Cpd	$83 - $200	37%
Qualcare Lynx Wc Cpd	$83 - $200	37%
UnitedHealthcare	$83 - $200	37%
Upmc For Life Mgg	$83 - $200	37%
Wellcare Mgg	$83 - $200	37%

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 $104.
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 Atlantic Rehabilitation Institute, LLC 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.