CMS Price Transparency Data

Culture, blood

Facility: Rio Grande Regional Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 87040
  • Insurance Median: $14
  • Cash Discount Price: $1,803
  • vs. Medicare Baseline: 1.36x Medicare
The contracted insurance negotiated median rate for a Culture, blood at Rio Grande Regional Hospital is $14. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,803. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 1.36x the Medicare baseline. Located in 101 E Ridge Rd, McAllen, TX.
Cash / Self-Pay
$1,803

Average discount available for prompt cash payment at this facility.

Insurance Median
$14

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: $1,803 (17471%)
Insurance Median: $14 (136%)
Cash: $1,803 (17471% of Medicare)
Ins. Median: $14 (136% 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.

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 $9 - $10 87%
Driscoll Children'S Health Plan $9 87%
Texas Health Network $9 87%
United $9 - $811 87%
Allegian Health $10 - $721 97%
Blue Cross Blue Shield $10 - $811 97%
Cigna $10 - $38 97%
Humana $10 - $36 97%
Independent Medical System $10 97%
Molina Healthcare $10 - $25 97%
Triwest Healthcare Alliance $10 97%
Wellmed $10 97%
American Health Plan $11 107%
Molina $11 107%
Physicians Health Choice $11 107%
Prominence Health $11 107%
Provider Partners Health Plan Of Texas $11 107%
Shared Health $11 107%
Superior Health Plan $11 - $126 107%
Triwest Health Alliance $11 107%
Universal Health Care $12 116%
Superior $16 155%
Corvel Corporation $20 194%
Focus Healthcare $21 203%
Omni Healthcare $22 213%
Oscar $24 233%
Healthcare Highways $31 300%
Texas Workforce Commission $433 4196%
Averde Health $595 5766%
Healthsmart Preferred Care $775 - $1,533 7510%
First Health $1,037 10048%
National Healthcare Solutions $1,082 10484%
Southwest Medical $1,082 10484%
Coastal Comp $1,172 11357%
Usa Managed Care $1,172 - $1,443 11357%
Ppo Next/ Medical Control $1,352 13101%
Beech Street $1,443 13983%
Multiplan $1,443 13983%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 101 E Ridge Rd, McAllen, TX 78503
  • CMS Rating: ★★★★☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals