CMS Price Transparency Data

Culture, blood

Facility: Baylor Scott & White the Heart Hospital Plano

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $47
Cash Discount Price: $189
vs. Medicare Baseline: 4.55x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Baylor Scott & White the Heart Hospital Plano is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $189. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 4.55x the Medicare baseline. Located in 1100 Allied Drive, Plano, TX.

Cash / Self-Pay

$189

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $189 (1831%)

Insurance Median: $47 (455%)

Cash: $189 (1831% of Medicare)

Ins. Median: $47 (455% 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 455% of the Medicare baseline (a markup of 355%). 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
Aetna	$10 - $173	97%
Baylor Scott & White Health Plan	$10 - $183	97%
Humana	$10 - $221	97%
Triwest	$10	97%
UnitedHealthcare	$10 - $12	97%
American Health Plan	$11	107%
Blue Cross Blue Shield	$11 - $50	107%
Corvel	$11	107%
Healthspring	$11	107%
Prime Health Services	$11	107%
Procare Advantage	$11	107%
Superior Health Plan	$11 - $63	107%
Ambetter / Centene	$21	203%
Cigna	$155 - $183	1502%
Employers Health Network	$173	1676%
Quiktrip	$173	1676%
University Of Mary Hardin-Baylor	$183	1773%
Imagine Health	$198	1919%
Curative	$205	1986%
First Health	$221	2141%
Healthsmart	$221 - $236	2141%
Private Health Care System	$236	2287%

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 $189.
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 Baylor Scott & White the Heart Hospital Plano 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.