CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Boston Children's Hospital

Billing Code: 99203 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$168

about 1.4× the $118 Medicare rate · typically $78–$304

modeled estimate · not a bill or quote

What this hospital charges insurers

$308

Well above the fair price

about $140 over the fair price · 2.6× Medicare

Medicare pays $118 Fair price $168 This hospital $308 Cash price $657 Hospital's list price $657

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

Highest price of the 9 MA hospitals we have prices for — worth calling around.

Cheapest $27 Priciest $308

Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.

A fair price for a New patient office visit (30-44 min) is about $168 (about 1.4× the $118 Medicare rate). Boston Children's Hospital charges insurers about $308, or about $657 in cash — well above the fair price. Located in Boston, MA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $168. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$308 - $558	262%
Blue Cross Blue Shieldmajor	$371 - $434	316%
Aetnamajor	$394 - $551	335%
Cignamajor	$558 - $657	475%
Humanamajor	$591	503%
Ambetter (Centene)	$415	353%
CDPHP	$322 - $558	274%
Harvard Pilgrim	$334 - $444	284%
Tufts Health Plan	$404 - $405	344%
UniCare	$165	140%
+ 8 smaller / regional plans	$400 - $591

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 657), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99203.

Insurance Before you use insurance

Call your insurance company to confirm Boston Children's Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 99203.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Boston Children's Hospital

Compare: New patient office visit (30-44 min) at other MA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.