CMS Price Transparency Data

Breathing treatment (nebulizer)

Facility: Lovelace Westside Hospital

Billing Code: 94640 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 94640
Insurance Median: $369
Cash Discount Price: $123
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Breathing treatment (nebulizer) at Lovelace Westside Hospital is $369. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $223.72, this hospital’s rate is 1.65x the Medicare baseline. Located in 10501 Golf Course Road Nw, Albuquerque, NM.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$369

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: $123 (55%)

Insurance Median: $369 (165%)

Cash: $123 (55% of Medicare)

Ins. Median: $369 (165% 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]	$83	37%
Healthscope Benefits [2290]	$96	43%
UnitedHealthcare	$96	43%
Corvel Corp [2235]	$165	74%
Enablecomp [1350]	$168	75%
Worker'S Comp [2125]	$168	75%
Benefit Management [1175]	$205	92%
Magellan Behavioral Commercial [2895]	$205	92%
Presbyterian Health Plan [1830]	$205	92%
Zelis [2385]	$205	92%
Administrative Concepts [1005]	$369	165%
Aetna	$369	165%
Allied Benefit Systems Inc [1030]	$369	165%
Allied National Global Care [1035]	$369	165%
American Medical Security [2190]	$369	165%
Boon-Chapman [2375]	$369	165%
Coresource [1315]	$369	165%
Coventry Healthcare [1320]	$369	165%
Emblem Health [2430]	$369	165%
Employee Benefit Management Services [2445]	$369	165%
Healthcost Solutions [2415]	$369	165%
Multiplan [1680]	$369	165%
Mutual Of Omaha [1685]	$369	165%
National Telephone Cooperative [1700]	$369	165%
Northamerica Administrators [1725]	$369	165%
Pan American Life Insurance Co [1770]	$369	165%
Phcs [1780]	$369	165%
Trustmark [2030]	$369	165%

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 $123.
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 Westside 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.