CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Texas Health Presbyterian Hospital Plano

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $223
Cash Discount Price: $266
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Texas Health Presbyterian Hospital Plano is $223. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $266. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.64x the Medicare baseline. Located in 6200 W Parker Rd, Plano, TX.

Cash / Self-Pay

$266

Average discount available for prompt cash payment at this facility.

Insurance Median

$223

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: $266 (196%)

Insurance Median: $223 (164%)

Cash: $266 (196% of Medicare)

Ins. Median: $223 (164% 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.

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	$25 - $178	18%
Blue Cross Blue Shield	$25 - $657	18%
Parkland	$25 - $178	18%
UnitedHealthcare	$25 - $797	18%
Molina	$27 - $192	20%
Superior Wellcare	$27 - $187	20%
Aetna	$85 - $1,020	63%
Fort Worth Firefighters	$91 - $888	67%
City Of Fort Worth	$97 - $684	72%
Cigna	$115 - $1,369	85%
Quick Trip	$124 - $916	91%
American Health	$132	97%
Healthspring	$134	99%
Humana	$137	101%
Phcs	$144 - $1,084	106%
Healthsmart	$155 - $1,222	114%
Multiplan	$180 - $1,266	133%
Galaxy	$182 - $1,280	134%
Usa	$182 - $1,280	134%

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 $266.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Health Presbyterian Hospital Plano is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99214.
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.