CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Boston Children's Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $560
Cash Discount Price: $1,338
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Boston Children's Hospital is $560. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,338. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 4.13x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$1,338

Average discount available for prompt cash payment at this facility.

Insurance Median

$560

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: $1,338 (987%)

Insurance Median: $560 (413%)

Cash: $1,338 (987% of Medicare)

Ins. Median: $560 (413% 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 413% of the Medicare baseline (a markup of 313%). 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
Unicare	$234	173%
Cdphp	$305 - $1,746	225%
UnitedHealthcare	$308 - $1,746	227%
Harvard Pilgrim	$316 - $1,759	233%
Blue Cross Blue Shield	$351 - $1,527	259%
United	$372 - $1,716	274%
Aetna	$373 - $1,722	275%
Mgb/Allways	$378 - $1,519	279%
Tufts Public Plan	$382 - $1,265	282%
United Ri Nj Ny	$392 - $1,294	289%
Ambetter / Centene	$393 - $1,298	290%
Carelon Strategies/Bhs	$404 - $1,335	298%
Carelon/Beacon	$466 - $1,540	344%
Fallon	$475 - $1,583	350%
Health New England	$503 - $1,660	371%
Cigna	$529 - $1,854	390%
Ets/Lifetrac	$529 - $1,746	390%
Interlink Transplant	$529 - $1,746	390%
Community Health Options	$560 - $1,849	413%
Humana	$560 - $1,849	413%
Coventry/Hcvm/First Health	$572 - $1,890	422%
Multiplan/Phcs	$572 - $1,951	422%

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 $1,338.
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 Boston Children's 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.