CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Texas Health Presbyterian Hospital Kaufman

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $199
Cash Discount Price: $433
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Texas Health Presbyterian Hospital Kaufman is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $433. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.09x the Medicare baseline. Located in 850 Ed Hall, Kaufman, TX.

Cash / Self-Pay

$433

Average discount available for prompt cash payment at this facility.

Insurance Median

$199

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $433 (455%)

Insurance Median: $199 (209%)

Cash: $433 (455% of Medicare)

Ins. Median: $199 (209% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 209% of the Medicare baseline (a markup of 109%). 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
Amerigroup	$24 - $111	25%
Blue Cross Blue Shield	$24 - $426	25%
Parkland	$24 - $111	25%
UnitedHealthcare	$24 - $649	25%
Superior Wellcare	$25 - $116	26%
Molina	$26 - $120	27%
American Health	$92	97%
Healthspring	$94	99%
Humana	$96	101%
Aetna	$106 - $830	111%
Fort Worth Firefighters	$113 - $723	119%
City Of Fort Worth	$121 - $556	127%
Cigna	$142 - $1,114	149%
Quick Trip	$183 - $841	192%
Phcs	$215 - $990	226%
Healthsmart	$224 - $1,137	235%
Multiplan	$224 - $1,030	235%
Galaxy	$227 - $1,042	238%
Usa	$227 - $1,042	238%

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 $433.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Health Presbyterian Hospital Kaufman is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99213.
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.