CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Garnet Health Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $115
Cash Discount Price: $60
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Garnet Health Medical Center is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.51x the Medicare baseline. Located in 707 East Main Street, Middletown, NY.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $60 (27%)

Insurance Median: $115 (51%)

Cash: $60 (27% of Medicare)

Ins. Median: $115 (51% 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
Magnacare	$23 - $37	10%
Emblem Health	$42	19%
Aetna	$61 - $273	27%
Local 1199	$61	27%
Mvp	$70	31%
Blue Cross Blue Shield	$93 - $136	42%
Fidelis	$279	125%
Wellcare	$280	125%
Rojw	$478	214%
Northwell Direct	$560	250%
Geisinger Health Plan	$683	305%

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 $60.
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 Garnet Health 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.