CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Medical City Plano

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $176
  • Cash Discount Price: $345
  • vs. Medicare Baseline: 1.30x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Medical City Plano is $176. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $345. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.30x the Medicare baseline. Located in 3901 W 15Th St, Plano, TX.
Cash / Self-Pay
$345

Average discount available for prompt cash payment at this facility.

Insurance Median
$176

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)
Cash / Self-Pay: $345 (254%)
Insurance Median: $176 (130%)
Cash: $345 (254% of Medicare)
Ins. Median: $176 (130% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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
Superior Health Plan $21 - $121 15%
Cigna $38 - $243 28%
Aetna $46 - $1,049 34%
United $49 - $302 36%
Imperial Insurance Company $54 - $330 40%
Healthcare Highways $69 - $586 51%
Evry Health $73 - $448 54%
Lifecare Hospitals $92 - $520 68%
Curative Administrators $113 - $694 83%
Prominence Health Plan $113 - $694 83%
Blue Cross Blue Shield $136 - $770 100%
City Of Mckinney $138 - $781 102%
Fidelis Securecare $138 - $781 102%
National Choicecare $153 - $867 113%
Pc Texas Partners $168 - $954 124%
Physicians Coop Of Tx $168 - $954 124%
Rockport Health Group $168 - $954 124%
Averde Health, Inc $177 - $1,006 131%
Humana $198 146%
Multiplan Phcs $198 - $1,214 146%
Texas Healthcare Foundation Wc $199 - $1,127 147%
Coastal Comp Health Networks $214 - $1,214 158%
Mega Life $214 - $1,214 158%
Healthsmart Preferred Care $229 - $1,301 169%
Lewisville Isd/Dls Consulting $229 - $1,301 169%
Usa Managed Care $244 - $1,388 180%
Usc Health Services $244 - $1,388 180%
Galaxy Health Network $260 - $1,474 192%
Independent Medical Systems $283 - $1,735 209%
National Healthcare Solutions $283 - $1,735 209%
Unicare $306 - $1,735 226%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3901 W 15Th St, Plano, TX 75075
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals