CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Phoenix Children's Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 99214
  • Insurance Median: $109
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.80x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Phoenix Children's Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.80x the Medicare baseline. Located in 1919 East Thomas Road, Phoenix, AZ.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$109

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%)
Insurance Median: $109 (80%)
Ins. Median: $109 (80% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Ahccs $23 - $99 17%
Ahc Apipa $40 29%
Ahc Cmdp $40 29%
Ahc Crs $40 - $99 29%
Ahc Ihs $40 29%
Ahc Mercy Care $40 29%
Ahc University $45 33%
Ahc Healthchoice $52 38%
Ahc Lcd $55 41%
Healthcomp $94 - $117 69%
Intel $94 - $117 69%
Ahc Care First $99 73%
UnitedHealthcare $102 - $139 75%
Aetna $107 - $215 79%
Antidote $152 - $190 112%
Cigna $163 - $234 120%
Multiplan $187 - $234 138%
Selfpay $220 162%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1919 East Thomas Road, Phoenix, AZ 85016
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens