CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Harlem Hospital Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 94640
  • Insurance Median: $120
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.54x Medicare
The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Harlem Hospital Center is $120. 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 0.54x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$120

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: $120 (54%)
Ins. Median: $120 (54% 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.

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 $7 - $265 3%
Emblem $9 - $301 4%
Wellcare $10 4%
Fidelis $13 - $342 6%
Aetna $16 - $17 7%
Blue Cross Blue Shield $60 - $265 27%
Oxford $69 - $76 31%
United $83 - $147 37%
Metroplus $110 - $265 49%
Amidacare $118 53%
Carelon $118 - $280 53%
Senior Whole Health $118 53%
United Behavioral Health $118 - $130 53%
Affinity $120 - $265 54%
Carelon (Amida Care) $120 54%
Vnsny $120 - $241 54%
Centerlight $216 97%
Cigna $241 108%
Elderplan $241 108%
Vaccn $241 108%
Centers Plan For Healthy Living $250 112%
Magnacare $323 144%
Multiplan $345 154%
Oscar $361 161%
Local 1199 $366 164%
Villagecare Max $366 164%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 506 Lenox Avenue, New York, NY 10037
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Other
  • Hospital Type: Acute Care Hospitals