CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Texas Health Presbyterian Hospital Allen

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $200
Cash Discount Price: $256
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Texas Health Presbyterian Hospital Allen is $200. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.10x the Medicare baseline. Located in 1105 Central Expressway North, Allen, TX.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$200

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: $256 (269%)

Insurance Median: $200 (210%)

Cash: $256 (269% of Medicare)

Ins. Median: $200 (210% 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 210% of the Medicare baseline (a markup of 110%). 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	$18 - $136	19%
Blue Cross Blue Shield	$18 - $426	19%
Parkland	$18 - $136	19%
UnitedHealthcare	$18 - $649	19%
Molina	$19 - $147	20%
Superior Wellcare	$19 - $143	20%
Aetna	$64 - $830	67%
Fort Worth Firefighters	$69 - $723	72%
City Of Fort Worth	$74 - $556	78%
Cigna	$87 - $1,114	91%
American Health	$92	97%
Healthspring	$94	99%
Humana	$96	101%
Quick Trip	$111 - $841	117%
Healthsmart	$117 - $995	123%
Phcs	$131 - $990	138%
Multiplan	$136 - $1,030	143%
Galaxy	$138 - $1,042	145%
Usa	$138 - $1,042	145%

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 $256.
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 Allen 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.