CMS Price Transparency Data

Culture, blood

Facility: Mayaguez Medical Center Dr Ramon Emeterio Betances

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $20
Cash Discount Price: $42
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Mayaguez Medical Center Dr Ramon Emeterio Betances is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.94x the Medicare baseline. Located in Carr 2 Bo Sabalos, Mayaguez, PR.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $42 (407%)

Insurance Median: $20 (194%)

Cash: $42 (407% of Medicare)

Ins. Median: $20 (194% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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
Plan Vital	$10 - $15	97%
Medicare (plans)	$11	107%
Fondo Seguro Estado	$13	126%
Triple S	$14 - $25	136%
Acaa	$15	145%
Privado	$15	145%
Prossam	$20	194%
Humana	$24	233%
International Medical Card	$24	233%
Mmm	$28	271%
Mapfre	$30	291%
McS Classicare	$35	339%
Medical Card System	$35	339%
Palic	$35	339%

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 $42.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mayaguez Medical Center Dr Ramon Emeterio Betances is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87040.
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.