CMS Price Transparency Data

Culture, blood

Facility: Texas Childrens Hospital

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $215
Cash Discount Price: $226
vs. Medicare Baseline: 20.83x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Texas Childrens Hospital is $215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $226. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 20.83x the Medicare baseline. Located in 6621 Fannin Street, Houston, TX.

Cash / Self-Pay

$226

Average discount available for prompt cash payment at this facility.

Insurance Median

$215

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: $226 (2190%)

Insurance Median: $215 (2083%)

Cash: $226 (2190% of Medicare)

Ins. Median: $215 (2083% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 2083% of the Medicare baseline (a markup of 1983%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Superior Chip	$10 - $11	97%
Driscoll Children'S Health Plan Mcd	$11	107%
Community Health Choice	$18 - $2,872	174%
First Care Health Plan	$59 - $2,872	572%
UnitedHealthcare	$59 - $2,872	572%
Molina Mcd	$66 - $1,346	640%
Blue Cross Blue Shield	$77 - $2,827	746%
Community First Health Plan Mcd	$88 - $1,795	853%
Cook Children'S Health Plan	$88 - $1,795	853%
Cigna	$125 - $2,872	1211%
Aetna	$140 - $2,872	1357%
Kelseycare	$142 - $2,917	1376%
Healthsmart	$153 - $3,141	1483%
Evolutions Healthcare	$164 - $3,365	1589%
First Health	$193 - $4,263	1870%
Multiplan	$197 - $4,038	1909%
Galaxy Health Network	$208 - $4,263	2016%

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 $226.
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 Texas Childrens Hospital 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.