CMS Price Transparency Data
Office visit, established patient (30-39 min)
Facility: Seattle Children's Hospital
Billing Code: 99214 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 99214
- Insurance Median: $119
- Cash Discount Price: $140
- vs. Medicare Baseline: 0.88x Medicare
The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Seattle Children's Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.88x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$140
Average discount available for prompt cash payment at this facility.
Insurance Median
$119
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: $140 (103%)
Insurance Median: $119 (88%)
Cash: $140 (103% of Medicare)
Ins. Median: $119 (88% 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 |
|---|---|---|
| Child Hearing League [17301] | $35 - $90 | 26% |
| Hospice [17306] | $35 - $90 | 26% |
| Maple Lane School [17309] | $35 - $90 | 26% |
| Medicaid / KanCare | $35 - $90 | 26% |
| Chpw [15802] | $36 - $93 | 27% |
| Kaiser [15818] | $36 - $95 | 27% |
| Molina [15809] | $36 - $95 | 27% |
| Coordinated Care [15815] | $37 - $95 | 27% |
| Eye Quest [15894] | $37 - $104 | 27% |
| Icw Wellpoint [15822] | $37 - $95 | 27% |
| Opticare [15895] | $37 - $95 | 27% |
| UnitedHealthcare | $37 - $183 | 27% |
| Wellpoint [15814] | $37 - $95 | 27% |
| Usfhp [12208] | $57 - $117 | 42% |
| Asuris [11913] | $76 - $232 | 56% |
| Bridgespan Health Company [11906] | $76 - $232 | 56% |
| Regence [11903] | $76 - $232 | 56% |
| Regence [11909] | $76 - $232 | 56% |
| Chpw Cascade [12228] | $77 - $163 | 57% |
| Coordinated Care [12267] | $77 - $145 | 57% |
| Kaiser [13400] | $77 - $205 | 57% |
| Ubh Community & State [15819] | $79 - $110 | 58% |
| Kaiser [13401] | $91 - $205 | 67% |
| Regence Ump [12263] | $91 - $221 | 67% |
| Administrators [13102] | $105 - $203 | 77% |
| Molina Marketplace [12831] | $105 - $151 | 77% |
| United Behavioral Health [12234] | $110 | 81% |
| Asuris [11900] | $116 - $232 | 86% |
| Blue Cross Blue Shield | $116 | 86% |
| Aetna | $118 - $203 | 87% |
| Ameriben [11006] | $118 - $203 | 87% |
| Christian Brothers [11001] | $118 - $203 | 87% |
| Coresource [11004] | $118 - $203 | 87% |
| Ebms [11003] | $118 - $203 | 87% |
| Meritain [12251] | $118 - $242 | 87% |
| Moda [11009] | $118 - $203 | 87% |
| Preferred One [11008] | $118 - $203 | 87% |
| Web Tpa [11007] | $118 - $203 | 87% |
| Allegiance [12264] | $119 - $200 | 88% |
| Allied [13129] | $119 - $203 | 88% |
| Assurant Health Fc [13135] | $119 - $203 | 88% |
| Carpenters Trust [13100] | $119 | 88% |
| Cigna | $119 - $200 | 88% |
| Coastal Administrative [13140] | $119 - $203 | 88% |
| Coventry Fc [13112] | $119 | 88% |
| Ebms Fc [13144] | $119 - $203 | 88% |
| First Choice [13399] | $119 - $203 | 88% |
| Guardian Fc [13105] | $119 | 88% |
| Health Alliance [13233] | $119 - $203 | 88% |
| Ilwu-Pma [13158] | $119 - $203 | 88% |
| Kps [13109] | $119 | 88% |
| Loomis Benefits West [13161] | $119 - $203 | 88% |
| Mega Life [13111] | $119 | 88% |
| Meritain Health [13229] | $119 - $203 | 88% |
| Moda Fc [13219] | $119 - $203 | 88% |
| Myers Stevens & Toohey [13169] | $119 - $203 | 88% |
| Pacific Underwriters [13175] | $119 - $203 | 88% |
| Personify Fc [13155] | $119 - $203 | 88% |
| Personify [12270] | $119 - $200 | 88% |
| Principal Mutual Fc [13115] | $119 | 88% |
| Providence Health Plan [12289] | $119 - $200 | 88% |
| Providence Health Plan [13181] | $119 - $203 | 88% |
| Psew [13124] | $119 | 88% |
| Rehn & Associates [13182] | $119 - $203 | 88% |
| Sound Health And Wellness [13116] | $119 | 88% |
| Starmark [13103] | $119 - $203 | 88% |
| Tongass Timber Trust [13202] | $119 - $203 | 88% |
| Trusteed Plans [13186] | $119 - $203 | 88% |
| Trustmark Life Insurance [13203] | $119 - $203 | 88% |
| Tufts Health Plan [12279] | $119 - $200 | 88% |
| Welfare Pension [13120] | $119 - $203 | 88% |
| Wship [13121] | $119 - $203 | 88% |
| Zenith American Solutions [13195] | $119 - $203 | 88% |
| Zenith [13123] | $119 | 88% |
| Coastal Admin Svcs Contracted [12222] | $126 | 93% |
| Personify Contracted [12205] | $126 | 93% |
| Claritev [12299] | $133 - $242 | 98% |
| Ebms [12241] | $133 - $242 | 98% |
| Health Alliance [12266] | $133 - $242 | 98% |
| Humana | $133 - $242 | 98% |
| Key Benefit Admin [12276] | $133 - $242 | 98% |
| Medical Mutual [12233] | $133 - $242 | 98% |
| Moda [12842] | $133 - $242 | 98% |
| Nippon Life Insurance [12232] | $133 - $242 | 98% |
| Pehp [12235] | $133 - $242 | 98% |
| Preferredone Admin Services [12236] | $133 - $242 | 98% |
| Select Health [12277] | $133 - $242 | 98% |
| Altius Health Plan [12275] | $134 | 99% |
| Coventry Mhbp [12272] | $134 | 99% |
| Coventry [12244] | $134 | 99% |
| First Health [12210] | $134 | 99% |
| Hcc Medical [12274] | $134 | 99% |
| Lewermark [12286] | $134 | 99% |
| Medishare [12287] | $134 | 99% |
| Pacificsource [12245] | $134 | 99% |
| Rural Carrier Benefit Plan [12271] | $134 | 99% |
| Samaritan Health [12265] | $203 | 150% |
| Pb Premera [11601] | $222 | 164% |
| Premera [11600] | $222 | 164% |
| Pb Regence [11908] | $232 | 171% |