CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Children's Hospital of Philadelphia

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $449
Cash Discount Price: $1,020
vs. Medicare Baseline: 3.82x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at Children's Hospital of Philadelphia is $449. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,020. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 3.82x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$1,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$449

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $1,020 (868%)

Insurance Median: $449 (382%)

Cash: $1,020 (868% of Medicare)

Ins. Median: $449 (382% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 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 382% of the Medicare baseline (a markup of 282%). 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
Medicaid / KanCare	$168	143%
UnitedHealthcare	$169 - $561	144%
Health Partners	$192	163%
Aetna	$269 - $510	229%
Highmark Wholecare	$279	237%
Upmc Medical Assistance	$279	237%
Keystone First Chip	$316	269%
Keystone Health Plan East	$323	275%
Blue Cross Blue Shield	$360 - $409	306%
Geisinger Medical Assistance	$408	347%
Geisinger Health Plan Commercial	$449	382%
Jefferson Health Plans	$483	411%
Cigna	$510	434%
Highmark	$510	434%
Qualcare	$561	477%
First Health Network	$663	564%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$816	694%
Private Health Care Systems	$816	694%
Choice Care Network	$918	781%

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 $1,020.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Children's Hospital of Philadelphia is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
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.