CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Texas Health Presbyterian Hospital Allen

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $185
Cash Discount Price: $275
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Texas Health Presbyterian Hospital Allen is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $275. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 1.57x the Medicare baseline. Located in 1105 Central Expressway North, Allen, TX.

Cash / Self-Pay

$275

Average discount available for prompt cash payment at this facility.

Insurance Median

$185

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $275 (234%)

Insurance Median: $185 (157%)

Cash: $275 (234% of Medicare)

Ins. Median: $185 (157% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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	$18 - $185	15%
Blue Cross Blue Shield	$18 - $636	15%
Parkland	$18 - $185	15%
UnitedHealthcare	$18 - $880	15%
Molina	$19 - $200	16%
Superior Wellcare	$19 - $194	16%
Aetna	$64 - $1,126	54%
Fort Worth Firefighters	$69 - $980	59%
City Of Fort Worth	$74 - $755	63%
Cigna	$87 - $1,511	74%
Quick Trip	$111 - $1,140	94%
American Health	$114	97%
Healthspring	$116	99%
Healthsmart	$117 - $1,349	100%
Humana	$119	101%
Phcs	$131 - $1,343	111%
Multiplan	$136 - $1,397	116%
Galaxy	$138 - $1,413	117%
Usa	$138 - $1,413	117%

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 $275.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Texas Health Presbyterian Hospital Allen is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.