CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Orthocolorado Hosp at St Anthony Med Campus

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $154
Cash Discount Price: $159
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Orthocolorado Hosp at St Anthony Med Campus is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $159. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 0.69x the Medicare baseline. Located in 11650 W 2Nd Pl, Lakewood, CO.

Cash / Self-Pay

$159

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $159 (71%)

Insurance Median: $154 (69%)

Cash: $159 (71% of Medicare)

Ins. Median: $154 (69% 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	$8 - $225	4%
Blue Cross Blue Shield	$8 - $459	4%
Cigna	$8 - $507	4%
Devoted Health	$8	4%
Humana	$8	4%
Innovage	$8	4%
Kaiser	$8 - $113	4%
Medicare (plans)	$8	4%
UnitedHealthcare	$8 - $238	4%
Direct To Employer	$75 - $164	34%
Denver Health	$91 - $97	41%
Peak Health	$99 - $160	44%
United Colorado Doctor'S Plan	$145 - $154	65%
Centura Employee Plan	$194 - $205	87%
Multiplan	$271 - $348	121%

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 $159.
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 Orthocolorado Hosp at St Anthony Med Campus 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.