CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Cook Childrens Medical Center Prosper

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $250
Cash Discount Price: $408
vs. Medicare Baseline: 2.63x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Cook Childrens Medical Center Prosper is $250. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $408. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.63x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$408

Average discount available for prompt cash payment at this facility.

Insurance Median

$250

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: $408 (429%)

Insurance Median: $250 (263%)

Cash: $408 (429% of Medicare)

Ins. Median: $250 (263% 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 263% of the Medicare baseline (a markup of 163%). 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
Health Plan W. Uhrip	$42	44%
Health Plan W/O Uhrip	$42 - $294	44%
Aetna	$60 - $462	63%
Superior Health	$181	190%
Wellpoint	$190	200%
Blue Cross Blue Shield	$195 - $490	205%
United Community	$201 - $239	211%
UnitedHealthcare	$239 - $462	251%
Beacon	$250 - $294	263%
El Paso Health First	$250 - $294	263%
Tx Children Health	$250 - $294	263%
Firstcare	$263 - $435	276%
S&W Health	$457	480%
Cigna	$462	485%
Healthscope	$462	485%
Imagine Health	$462	485%
Humana	$473 - $479	497%
Multiplan	$473	497%
First Health	$479	503%
Galaxy Health	$490	515%
Healthsmart	$490	515%
Usamco	$501	526%

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 $408.
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 Cook Childrens Medical Center Prosper 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.