CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Methodist Celina Medical Center

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $134
Cash Discount Price: $211
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Methodist Celina Medical Center is $134. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 1.41x the Medicare baseline. Located in 1500 S Dallas Parkway, Celina, TX.

Cash / Self-Pay

$211

Average discount available for prompt cash payment at this facility.

Insurance Median

$134

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: $211 (222%)

Insurance Median: $134 (141%)

Cash: $211 (222% of Medicare)

Ins. Median: $134 (141% 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.

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
Medicare (plans)	$61 - $142	64%
Oscar Insurance Company [2057]	$75	79%
Molina [3017]	$83	87%
Wellpoint Marketplace Exchange [3071]	$89	93%
Aetna	$93 - $134	98%
90 Degree Benefit [3057]	$95	100%
Allied National [2031]	$95	100%
Entrust/90 Degree [2058]	$95	100%
Department Of Labor [8004]	$115	121%
Evry Health [1013]	$115	121%
Generic Workers Comp Tx Non Par [9010]	$115	121%
Generic Workers Comp Tx Par [8002]	$115	121%
Generic Workers Comp Tx Par [9011]	$115	121%
Sana Benefits [3069]	$115	121%
Velocity [3070]	$115	121%
Champva [1000]	$124	130%
Tricare	$124	130%
Triwest Wps [8010]	$124	130%
Veterans Administration [9001]	$124	130%
Blue Cross Blue Shield	$134 - $608	141%
Mcs Advantage, Inc Classicare [7021]	$134	141%
UnitedHealthcare	$134 - $142	141%
Ust Health Proof [1005]	$134	141%
Wellcare [7016]	$134	141%
American Health Advantage Of Texas [7099]	$140	147%
Cigna	$140 - $142	147%
Humana	$142	149%
Southwestern Health Resources Swhr [7015]	$142	149%
Health Plans Inc [5017]	$143	150%
Medical Cost Containment Professionals [3059]	$143	150%
Kempton Group Administrators, Tower Extrusions [3061]	$214	225%
Medicaid / KanCare	$318	334%

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 $211.
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 Methodist Celina Medical Center 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.