CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Children's Hospital of Philadelphia

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $430
Cash Discount Price: $978
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Children's Hospital of Philadelphia is $430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $978. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 3.17x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$978

Average discount available for prompt cash payment at this facility.

Insurance Median

$430

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: $978 (721%)

Insurance Median: $430 (317%)

Cash: $978 (721% of Medicare)

Ins. Median: $430 (317% 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 317% of the Medicare baseline (a markup of 217%). 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	$161	119%
UnitedHealthcare	$162 - $538	119%
Health Partners	$184	136%
Aetna	$257 - $489	190%
Highmark Wholecare	$267	197%
Upmc Medical Assistance	$267	197%
Keystone First Chip	$303	223%
Keystone Health Plan East	$309	228%
Blue Cross Blue Shield	$345 - $392	254%
Geisinger Medical Assistance	$391	288%
Geisinger Health Plan Commercial	$430	317%
Jefferson Health Plans	$462	341%
Cigna	$489	361%
Highmark	$489	361%
Qualcare	$538	397%
First Health Network	$635	468%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$782	577%
Private Health Care Systems	$782	577%
Choice Care Network	$880	649%

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 $978.
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 Children's Hospital of Philadelphia 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.