CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Jacobi Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $131
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.59x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Jacobi Medical Center is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.59x the Medicare baseline. Located in 1400 Pelham Parkway South, Bronx, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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%)

Insurance Median: $131 (59%)

Ins. Median: $131 (59% 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
Healthfirst	$8 - $289	4%
Emblem	$10 - $301	4%
Wellcare	$10	4%
Fidelis	$14 - $342	6%
Aetna	$17	8%
Blue Cross Blue Shield	$35 - $289	16%
Oxford	$69 - $76	31%
United	$83 - $161	37%
Metroplus	$121 - $289	54%
Amidacare	$128	57%
Carelon	$128 - $309	57%
Senior Whole Health	$128	57%
United Behavioral Health	$128 - $141	57%
Affinity	$131 - $289	59%
Carelon (Amida Care)	$131	59%
Vnsny	$131 - $241	59%
Centerlight	$237	106%
Cigna	$241	108%
Elderplan	$241	108%
Vaccn	$241	108%
Centers Plan For Healthy Living	$250	112%
Magnacare	$356	159%
Oscar	$361	161%
Multiplan	$380	170%
Local 1199	$403	180%
Villagecare Max	$403	180%

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 $X.
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 Jacobi 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.