CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: The Medical Center of Aurora & South Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $358
Cash Discount Price: $817
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at The Medical Center of Aurora & South Hospital is $358. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $817. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.60x the Medicare baseline. Located in 1501 S Potomac St, Aurora, CO.

Cash / Self-Pay

$817

Average discount available for prompt cash payment at this facility.

Insurance Median

$358

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: $817 (365%)

Insurance Median: $358 (160%)

Cash: $817 (365% of Medicare)

Ins. Median: $358 (160% 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
Vail Health	$121 - $128	54%
Kaiser	$159 - $298	71%
United	$165 - $378	74%
Cigna	$172 - $537	77%
Bright Health	$239 - $252	107%
Aetna	$259 - $443	116%
Pinnacol Workers Comp	$328	147%
Colorado Program For Children With Special Needs	$334 - $352	149%
Multiplan	$342 - $755	153%
Western Plains Community Health	$517 - $545	231%
Northcare	$557 - $587	249%
Physician Health Partners	$557 - $587	249%
Blue Cross Blue Shield	$589 - $621	263%
Medical Development International	$636 - $671	284%
Prime Health	$716 - $755	320%

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 $817.
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 Medical Center of Aurora & South 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.