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Office visit, new patient, 45-59 min

CPT 99204 · negotiated-rate distribution across hospitals in PA

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Hospitals
53
Min
$101.87
Median
$163.50
Max
$358.80
Range multiplier
3.5×

By payer (50 payers with published rates)

PayerHosp.RatesMinMedianMaxRange×
Aetna27247$20.00$181.44$605.8330.3×
Blue Cross Blue Shield26226$24.40$134.02$1,261.2651.7×
Cigna2298$25.62$184.86$510.0019.9×
UnitedHealthcare2589$21.00$138.42$596.7028.4×
Multiplan1084$95.16$352.07$666.907.0×
upmc health plan2468$22.00$99.41$490.0022.3×
intergroup1458$109.80$396.00$3,704.0033.7×
geisinger1745$27.80$125.61$560.0020.1×
First Health1242$77.66$352.60$595.007.7×
pa health & wellness2034$26.35$154.01$211.688.0×
amerihealth caritas2130$31.22$141.08$200.906.4×
private health care systems1326$254.99$430.18$680.002.7×
wirerope works424$67.83$228.24$390.315.8×
america's choice424$109.80$369.45$631.805.8×
Humana922$106.05$508.30$722.506.8×
upmc work partners2020$193.76$208.03$235.331.2×
health partners plans (jefferson health plan)1115$30.16$136.28$136.284.5×
Medicaid213$71.73$107.40$180.192.5×
keystone first513$73.80$190.44$252.133.4×
preferred healthcare system612$228.50$228.50$383.201.7×
three rivers provider network39$139.50$234.59$631.804.5×
selectcare48$400.00$474.75$680.001.7×
Oscar Health38$58.65$91.63$121.722.1×
health payors organization38$425.00$437.50$567.801.3×
prime health services38$103.50$161.70$214.802.1×
occunet26$120.75$188.65$250.602.1×
fidelis26$375.00$375.00$501.001.3×
health coalition partners46$400.00$430.83$506.101.3×
health partners plans36$71.73$71.73$71.731.0×
ibc26$137.64$137.64$137.641.0×
innovage26$86.25$134.75$179.002.1×
abington pro ibc14$120.19$124.48$150.051.2×
galaxy health plan14$300.00$430.00$560.001.9×
national provider network24$410.00$523.12$636.241.6×
qualcare14$334.18$389.05$443.921.3×
pennsylvania health and wellness33$201.75$201.75$201.751.0×
Anthem BCBS13$246.54$281.25$329.691.3×
jup health partners chip13$90.37$126.46$141.571.6×
univera13$74.25$163.35$217.802.9×
gateway health plan33$108.44$151.15$151.151.4×
magellan health12$115.43$554.22$993.008.6×
jup geisinger commercial12$192.52$204.13$215.731.1×
jup community behavioral health12$128.79$134.28$139.771.1×
prime net12$592.86$592.86$592.861.0×
independent health12$206.88$213.75$220.611.1×
Medicare12$106.97$113.55$120.141.1×
jup pa health_wellness11$117.48$117.48$117.481.0×
health plan of upper ohio valley11$233.31$233.31$233.311.0×
pa health_wellness chc11$78.00$78.00$78.001.0×
pa health and wellness inc11$108.44$108.44$108.441.0×

By hospital (top 200 by negotiated median, descending)

HospitalCitySTPayersGrossCashNeg minNeg medianNeg max
Upmc Northwest HospitalSenecaPA13$598.00$358.80$36.08$358.80$3,704.00
Upmc ShadysidePittsburghPA19$500.00$300.00$36.08$350.00$636.41
Upmc MckeesportMckeesportPA13$850.00$510.00$36.08$327.25$722.50
Upmc Bedford Memorial HospitalEverettPA17$479.00$287.40$36.08$301.05$431.10
Upmc - Presbyterian ShadysidePittsburghPA5$668.00$400.80$121.78$300.00$567.80
Upmc Horizon HospitalGreenvillePA17$723.00$433.80$36.08$287.97$614.55
Upmc East HospitalMonroevillePA13$709.00$425.40$36.08$276.51$585.14
Upmc PassavantPittsburghPA14$505.00$303.00$36.08$233.31$558.02
Upmc St MargaretPittsburghPA12$648.00$388.80$36.08$219.29$585.14
Upmc Mercy HospitalPittsburghPA16$500.00$300.00$36.08$216.87$450.00
Charles Cole Memorial HospitalCoudersportPA14$700.00$420.00$61.30$211.68$574.00
Upmc HamotEriePA14$495.00$297.00$63.91$198.00$419.02
Upmc JamesonNew CastlePA12$723.00$433.80$27.66$196.77$636.24
WellsboroWellsboroPA14$702.00$421.20$21.96$163.50$666.90
Curahealth Heritage ValleyBeaverPA7$328.00$88.56$90.37$145.63$328.00
Thomas Jefferson Univ. HospitalPhiladelphiaPA5$301.00$71.73$137.64$252.13
Altoona Regional Health SystemAltoonaPA12$457.00$274.20$20.00$134.02$371.06
Upmc Magee-Womens HospitalPittsburghPA12$457.00$274.20$20.00$134.02$371.06
Upmc Childrens Hospital Of PghPittsburghPA12$457.00$274.20$20.00$134.02$371.06
The Childrens Home Of PittsburghPittsburghPA12$457.00$274.20$20.00$134.02$371.06
Lock Haven HospitalLock HavenPA15$702.00$421.20$41.85$133.24$631.80
Divine Providence HospitalWilliamsportPA15$702.00$421.20$41.85$133.24$631.80
Williamsport Hospital & Medical CtrWilliamsportPA15$702.00$421.20$41.85$133.24$631.80
Aria HealthPhiladelphiaPA12$532.00$73.80$131.87$360.89
American Oncologic HospialPhiladelphiaPA10$716.00$68.18$129.17$443.92
Temple University HospitalPhiladelphiaPA16$716.00$21.05$116.96$1,201.20
Jeanes HospitalPhiladelphiaPA14$716.00$21.05$101.87$1,261.26
Pennsylvania Psychiatric InstituteHarrisburgPA0$495.00$84.94
Holy Spirit HospitalCamp HillPA0$495.00$118.26
Chestnut Hill HospitalPhiladelphiaPA0$498.00$124.50
Uniontown HospitalUniontownPA0$837.00$418.50
Reading Hospital And Medical CenterReadingPA0$498.00$348.60
Clarion HospitalClarionPA0$337.00$188.72
St. Joseph Medical CenterReadingPA0$115.00$29.91
Windber Hospital Inc.WindberPA0$305.00$259.25
Pottstown Memorial Medical CenterPottstownPA0$498.00$124.50
Wayne Memorial HospitalHonesdalePA0$252.00$176.40
Phoenixville HospitalPhoenixvillePA0$498.00$124.50
Miners HospitalHastingsPA0$380.00$152.00
Westmoreland Regional HospitalGreensburgPA0$293.00$175.80
Butler Memorial HospitalButlerPA0$337.00$235.90
The Chester County HospitalWest ChesterPA0$342.00$342.00
Doylestown HospitalDoylestownPA0$359.00$359.00
Frick HospitalMount PleasantPA0$293.00$175.80
Latrobe Area HospitalLatrobePA0$290.00$174.00
Presbyterian Medical CenterPhiladelphiaPA0$965.00$965.00
Physicians Care Surgical HospitalRoyersfordPA0$385.00
Meyersdale Community HospitalMeyersdalePA0$383.00$153.20
Miners HospitalHastingsPA0$380.00$152.00
Lifecare Hospitals Of Chester CountyWest ChesterPA0$342.00$342.00
Allied Services Rehab HospitalScrantonPA0$410.00
John Heinz Instit. Of Rehab MedicineWilkes-BarrePA0$410.00
Penn State Hershey Rehabilitation LlHummelstownPA0$115.00$29.91

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.