CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Texas Childrens Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $285
Cash Discount Price: $418
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Texas Childrens Hospital is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $418. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.99x the Medicare baseline. Located in 6621 Fannin Street, Houston, TX.

Cash / Self-Pay

$418

Average discount available for prompt cash payment at this facility.

Insurance Median

$285

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: $418 (439%)

Insurance Median: $285 (299%)

Cash: $418 (439% of Medicare)

Ins. Median: $285 (299% 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 299% of the Medicare baseline (a markup of 199%). 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
First Care Health Plan	$52 - $676	55%
UnitedHealthcare	$52 - $1,352	55%
Driscoll Children'S Health Plan Mcd	$58 - $317	61%
Molina Mcd	$58 - $317	61%
Blue Cross Blue Shield	$67 - $665	70%
Community Health Choice	$68 - $676	71%
Community First Health Plan Mcd	$77 - $422	81%
Cook Children'S Health Plan	$77 - $422	81%
Cigna	$109 - $676	115%
Aetna	$123 - $676	129%
Kelseycare	$125 - $686	131%
Healthsmart	$134 - $739	141%
Evolutions Healthcare	$144 - $792	151%
First Health	$169 - $1,003	178%
Multiplan	$173 - $950	182%
Galaxy Health Network	$182 - $1,003	191%

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 $418.
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 Childrens Hospital 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.