CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Bella Vista Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 77067
Insurance Median: $80
Cash Discount Price: $85
vs. Medicare Baseline: 0.63x Medicare

The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Bella Vista Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 0.63x the Medicare baseline. Located in Carr 349 Km 2 7 Cerro Las Mesas, Mayaguez, PR.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)

Cash / Self-Pay: $85 (67%)

Insurance Median: $80 (63%)

Cash: $85 (67% of Medicare)

Ins. Median: $80 (63% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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
Triple S Vital	$20 - $94	16%
Fondo Del Seguro Del Estado	$28	22%
Triple S	$42	33%
Medicare (plans)	$44 - $80	35%
Mcs	$50 - $59	40%
Asociacion Maestros (Prossam)	$70	55%
International Medical Card	$70	55%
First Medical Vital	$71	56%
Plan Salud Menonita Vital	$72	57%
Preferred Medical Choice(Pmc)	$80	63%
Servicios De Salud Bella Vista	$80	63%
Triple S Advantage	$80 - $97	63%
Champva	$97	77%
Tricare	$97	77%
UnitedHealthcare	$97	77%
Mapfre Life Insurance Life Insurance	$101	80%

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 $85.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 77067.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Bella Vista Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 77067.
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.