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Office visit, new patient, 45-59 min

CPT 99204 · negotiated-rate distribution across hospitals in MA

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Hospitals
11
Min
$137.88
Median
$170.73
Max
$399.59
Range multiplier
2.9×

By payer (50 payers with published rates)

PayerHosp.RatesMinMedianMaxRange×
UnitedHealthcare757$69.83$158.78$478.956.9×
Blue Cross Blue Shield756$20.00$166.89$1,261.2663.1×
institution [10406]452$85.41$206.00$455.005.3×
Aetna732$94.19$276.33$651.566.9×
Medicaid418$67.98$159.56$401.965.9×
Cigna513$25.35$172.50$537.8721.2×
First Health510$154.50$341.25$579.753.8×
correctional care [11003]310$85.41$159.56$161.531.9×
connecticare [11105]49$206.00$455.00$773.003.8×
grants [20507]49$206.00$455.00$773.003.8×
harvard pilgrim [10701]39$217.03$217.03$217.031.0×
fallon mcaid carelon hlth [29]49$206.00$455.00$773.003.8×
mgb mcr [10124]48$89.68$164.53$169.611.9×
Multiplan38$154.50$256.13$579.753.8×
tufts connectorcare [10507]48$145.28$271.41$274.771.9×
masshealth mcd mbhp [38]37$206.00$228.00$564.002.7×
Medicare47$85.41$159.56$161.531.9×
evernorth behavioral health [27]37$164.80$182.40$451.202.7×
geisinger17$108.44$284.28$589.985.4×
senior whole health [10110]46$91.39$170.73$172.841.9×
automobile [10401]26$206.00$228.00$455.002.2×
CHAMPVA46$117.83$145.39$163.911.4×
commonwealth care mcr [10115]36$89.68$167.53$169.611.9×
devon health16$338.10$528.22$701.682.1×
fallon mcr [10105]36$89.68$167.53$169.611.9×
optum transplant [20601]26$206.00$228.00$455.002.2×
tufts [11201]46$23.04$37.71$400.8917.4×
tufts dual [10111]36$85.41$159.56$161.531.9×
wellfleet [11106]26$185.40$205.20$409.502.2×
wellsense cc carelon hlth [20]26$206.00$228.00$455.002.2×
hsno/free care [10801]44$294.30$672.16$680.812.3×
harvard pilgrim mcr supp [20203]24$89.68$128.61$167.531.9×
tufts mcr [10112]24$167.53$168.57$169.611.0×
tufts us family [11203]44$159.56$160.55$161.531.0×
workers compensation [20501]44$150.71$150.71$150.711.0×
tufts mcr supp [20209]24$89.68$128.61$167.531.9×
fallon mcr supp [20202]24$167.53$168.57$169.611.0×
fallon connectorcare [10503]24$58.00$136.84$215.673.7×
eternalhealth mcr replace [10116]24$89.68$128.61$167.531.9×
pennsylvania health and wellness14$112.96$171.63$278.022.5×
innovage13$86.25$134.75$179.002.1×
hp optum bh [32]23$564.00$709.00$773.001.4×
fallon carelon hlth [28]23$564.00$709.00$773.001.4×
keystone first13$106.71$166.71$221.462.1×
point comfort13$138.00$215.60$286.402.1×
occunet13$120.75$188.65$250.602.1×
wellpoint [11112]33$74.23$155.49$155.492.1×
hne [11108]22$205.21$205.21$205.211.0×
mgb [allways]12$100.16$129.47$158.781.6×
qualcare inc12$535.29$553.07$570.841.1×

By hospital (top 200 by negotiated median, descending)

HospitalCitySTPayersGrossCashNeg minNeg medianNeg max
Beth Israel Deaconess - PlymouthPlymouthMA9$697.00$145.18$91.33$399.59$650.51
Chestnut Hill Benevolent AssociationChestnut HillMA14$716.00$33.12$180.74$1,261.26
Healthalliance-ClintonLeominsterMA30$773.00$773.00$23.04$172.84$773.00
Marlborough HospitalMarlboroughMA36$455.00$455.00$35.91$170.73$672.16
Umass Memorial Medical CenterWorcesterMA36$455.00$455.00$35.91$170.73$672.16
Harrington Memorial HospitalSouthbridgeMA27$564.00$564.00$150.71$169.61$680.81
Whittier Hospital-BradfordBradfordMA12$550.00$550.00$20.00$137.88$175.24
North Adams Regional HospitalNorth AdamsMA0$763.03$724.88
Fairview HospitalGreat BarringtonMA0$763.03$724.88
Berkshire Medical CenterPittsfieldMA0$763.03$724.88
North Shore Medical CenterSalemMA0$1,735.28$1,735.28

Median is taken across all payer × plan combinations the hospital publishes. Cash and gross are the latest snapshot values. Range multiplier (max ÷ min) is a quick way to see which hospitals or payers vary the most.