CMS Price Transparency Data

Culture, blood

Facility: Seton Medical Center Harker Heights

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $90
Cash Discount Price: $23
vs. Medicare Baseline: 8.72x Medicare

The contracted insurance negotiated median rate for a Culture, blood at Seton Medical Center Harker Heights is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $23. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 8.72x the Medicare baseline. Located in 850 W Central Texas Expressway, Harker Heights, TX.

Cash / Self-Pay

$23

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $23 (223%)

Insurance Median: $90 (872%)

Cash: $23 (223% of Medicare)

Ins. Median: $90 (872% 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 872% of the Medicare baseline (a markup of 772%). 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
Healthscope Benefits [2290]	$41	397%
UnitedHealthcare	$41 - $90	397%
Aetna	$43 - $132	417%
Healthcare Highways [2210]	$90	872%
Medicaid / KanCare	$90 - $247	872%
Oncology Patient Assistance Programs [2295]	$90	872%
Selecthealth [3740]	$90	872%
Web Tpa [2115]	$90 - $184	872%
Oscar Exchange [6080]	$100	969%
Humana	$151	1463%
Blue Cross Blue Shield	$170	1647%
First Care Commercial [1371]	$172	1667%
Allied Benefit Systems Inc [1030]	$184	1783%
Cigna	$199	1928%

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 $23.
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 Seton Medical Center Harker Heights 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.