CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Texas Childrens Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $472
Cash Discount Price: $674
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Texas Childrens Hospital is $472. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $674. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.48x the Medicare baseline. Located in 6621 Fannin Street, Houston, TX.

Cash / Self-Pay

$674

Average discount available for prompt cash payment at this facility.

Insurance Median

$472

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: $674 (497%)

Insurance Median: $472 (348%)

Cash: $674 (497% of Medicare)

Ins. Median: $472 (348% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 348% of the Medicare baseline (a markup of 248%). 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	$71 - $1,118	52%
UnitedHealthcare	$71 - $1,352	52%
Driscoll Children'S Health Plan Mcd	$79 - $524	58%
Molina Mcd	$79 - $524	58%
Blue Cross Blue Shield	$92 - $1,101	68%
Community Health Choice	$93 - $1,118	69%
Community First Health Plan Mcd	$106 - $699	78%
Cook Children'S Health Plan	$106 - $699	78%
Cigna	$150 - $1,118	111%
Aetna	$169 - $1,118	125%
Kelseycare	$172 - $1,136	127%
Healthsmart	$185 - $1,223	136%
Evolutions Healthcare	$198 - $1,310	146%
First Health	$232 - $1,660	171%
Multiplan	$238 - $1,572	176%
Galaxy Health Network	$251 - $1,660	185%

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 $674.
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 Childrens Hospital 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.