CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lovelace Medical Center

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $362
Cash Discount Price: $121
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lovelace Medical Center is $362. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.62x the Medicare baseline. Located in 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$362

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: $121 (54%)

Insurance Median: $362 (162%)

Cash: $121 (54% of Medicare)

Ins. Median: $362 (162% 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
The Health Plan [2915]	$81	36%
Healthscope Benefits [2290]	$103	46%
UnitedHealthcare	$103	46%
Corvel Corp [2235]	$162	72%
Enablecomp [1350]	$165	74%
Worker'S Comp [2125]	$165	74%
Benefit Management [1175]	$201	90%
Magellan Behavioral Commercial [2895]	$201	90%
Presbyterian Health Plan [1830]	$201	90%
Zelis [2385]	$201	90%
Administrative Concepts [1005]	$362	162%
Aetna	$362	162%
Allied Benefit Systems Inc [1030]	$362	162%
Allied National Global Care [1035]	$362	162%
American Medical Security [2190]	$362	162%
Boon-Chapman [2375]	$362	162%
Coresource [1315]	$362	162%
Coventry Healthcare [1320]	$362	162%
Emblem Health [2430]	$362	162%
Employee Benefit Management Services [2445]	$362	162%
Healthcost Solutions [2415]	$362	162%
Multiplan [1680]	$362	162%
Mutual Of Omaha [1685]	$362	162%
National Telephone Cooperative [1700]	$362	162%
Northamerica Administrators [1725]	$362	162%
Pan American Life Insurance Co [1770]	$362	162%
Phcs [1780]	$362	162%
Trustmark [2030]	$362	162%

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 $121.
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 Lovelace 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.