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Office visit, new patient, 45-59 min

CPT 99204 · negotiated-rate distribution across hospitals in TX

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Hospitals
44
Min
$80.00
Median
$259.50
Max
$3,840.00
Range multiplier
48.0×

By payer (50 payers with published rates)

PayerHosp.RatesMinMedianMaxRange×
Blue Cross Blue Shield38178$47.00$274.53$8,427.00179.3×
UnitedHealthcare3384$20.23$198.32$687.9634.0×
Aetna2370$68.89$257.34$641.209.3×
Humana1640$88.31$380.36$705.608.0×
Cigna1834$55.11$251.15$1,800.0032.7×
Medicaid1123$1.00$170.52$704.00704.0×
Anthem BCBS222$114.67$162.17$162.171.4×
Multiplan1721$198.05$441.70$778.603.9×
First Health1217$242.00$661.50$732.803.0×
healthsmart715$64.00$784.98$784.9812.3×
commercial | galaxy | all plans912$520.20$521.55$567.901.1×
commercial | phcs | all plans58$198.05$392.18$425.932.2×
assurant health48$582.12$582.12$582.121.0×
web tpa48$396.90$396.90$396.901.0×
superior health plan36$145.00$202.87$313.002.2×
scott & white56$264.60$264.60$650.362.5×
commercial | nppn | all plans55$489.60$489.60$489.601.0×
Medicare15$124.61$137.35$138.661.1×
wellmed25$65.00$70.38$248.483.8×
commercial | usa health network | all plans55$520.20$520.20$520.201.0×
galaxy health network35$80.00$284.00$633.607.9×
pphp14$90.07$139.62$173.311.9×
commercial | healthsmart | ppo44$428.40$428.40$428.401.0×
patoka valley tier 124$162.17$162.17$162.171.0×
patoka valley tier 224$162.17$162.17$162.171.0×
city of san angelo44$122.60$122.60$122.601.0×
mhs care connect24$114.67$114.67$114.671.0×
Medicare Advantage14$88.31$136.87$169.911.9×
txp optum health (transplant)14$485.48$567.92$687.001.4×
prime health services13$544.00$709.00$1,170.002.2×
friday health insurance company13$1,088.00$1,417.00$2,340.002.2×
oscar13$167.00$218.00$360.002.2×
phcs12$687.00$687.00$687.001.0×
commercial | healthsmart | all plans22$428.40$428.40$428.401.0×
commercial | health first | all plans12$306.00$312.00$318.001.0×
commercial | firstcare | all plans22$139.80$139.80$139.801.0×
health partners open network22$214.84$214.84$214.841.0×
health industry trust and welfare plan12$418.77$526.19$633.601.5×
accountable health plans of america12$395.51$496.96$598.401.5×
galaxy health12$888.52$888.52$888.521.0×
Molina22$168.87$244.74$320.601.9×
choicecare network ppo, pos, med adv12$372.24$467.72$563.201.5×
methodist12$521.66$521.66$521.661.0×
choice one inc ppo12$372.24$467.72$563.201.5×
imagine health12$641.20$641.20$641.201.0×
great west healthcare of texas12$409.46$514.49$619.521.5×
equifax healthcare12$778.60$778.60$778.601.0×
choice one inc epo/pos12$335.02$420.95$506.881.5×
medavant healthcare solutions12$372.24$467.72$563.201.5×
encore exclusive22$162.17$162.17$162.171.0×

By hospital (top 200 by negotiated median, descending)

HospitalCitySTPayersGrossCashNeg minNeg medianNeg max
Clay County Memorial HospitalHenriettaTX5$336.00$235.00$64.00$82.00$108.00
Baylor County Hospital DistrictSeymourTX9$434.00$303.80$65.00$80.00$263.08
Crescent Medical Center LancasterLancasterTX5$1,800.00$1,170.00$167.00$709.00$2,340.00
Childrens Medical Center Of PlanoPlanoTX31$916.00$687.00$144.29$641.20$888.52
San Angelo Community Medical CenterSan AngeloTX11$882.00$441.00$122.60$635.04$784.98
Shannon Medical CenterSan AngeloTX11$882.00$441.00$122.60$635.04$784.98
Big Spring State HospitalBig SpringsTX11$882.00$441.00$122.60$635.04$784.98
River Crest HospitalSan AngeloTX11$882.00$441.00$122.60$635.04$784.98
Driscoll Childrens HospitalCorpus ChristiTX2$1,230.90$246.18$165.82$582.91$1,000.00
Dimmit Regional Hospital DistrictCarrizo SpringsTX3$640.00$384.00$171.00$432.00$614.00
Rice Medical CenterEagle LakeTX19$704.00$492.80$1.00$409.46$704.00
St Lukes Health Memorial San AugustSan AugustineTX7$631.00$220.85$47.00$407.48$567.90
Chi St Lukes Health Mem LivingstonLivingstonTX6$631.00$220.85$47.00$391.89$567.90
Chi St Lukes Health Memorial LufkinLufkinTX7$631.00$220.85$47.00$391.89$567.90
Baylor Orthopedic And Spine HospitalArlingtonTX1$1,820.00$3,840.00$8,427.00
St. Lukes Patients Medical CenterPasadenaTX6$612.00$214.20$184.96$330.57$520.20
St. Lukes Lakeside HospitalThe WoodlandsTX9$612.00$214.20$98.00$321.33$520.20
St. Lukes Sugar Land HospitalSugar LandTX9$612.00$214.20$98.00$321.33$520.20
St. Lukes The Woodlands HospitalThe WoodlandsTX9$612.00$214.20$98.00$321.33$520.20
St Lukes Hospital At The VintageHoustonTX9$612.00$214.20$98.00$321.33$520.20
Brazosport Regional Health SystemLake JacksonTX2$636.00$222.60$273.21$318.00$367.78
Chi St Lukes Health Baylor Med CtrHoustonTX10$612.00$214.20$99.00$282.40$520.20
Mccamey County Hospital DistrictMccameyTX14$316.00$316.00$190.00$278.00$316.00
Eastland Memorial HospitalEastlandTX3$363.00$182.00$225.00$259.50$327.00
North Texas Medical CenterGainsvilleTX9$403.00$101.00$131.00$242.00$371.00
Heritage Park Surgical HospitalShermanTX1$162.00$97.20$238.44$238.44$238.44
Crane County Hospital DistrictCraneTX2$389.00$272.00$226.00$237.00$350.00
Limestone Medical CenterGroesbeckTX8$585.90$351.54$88.31$235.99$468.72
St. Joseph Regional Health CenterBryanTX3$233.00$81.55$173.00$214.62$233.00
College Station Medical CenterCollege StationTX3$233.00$81.55$173.00$214.62$233.00
Grimes St. Joseph Health CenterNavasotaTX3$233.00$81.55$173.00$214.62$233.00
Falls Community Hospital And ClinicMarlinTX6$405.00$324.00$65.00$214.55$590.31
Burleson St. Joseph Health CenterCaldwellTX5$233.00$81.55$139.80$203.88$233.00
Golden Plains Community HospitalBorgerTX6$599.00$419.30$55.11$198.90$407.32
Madison St. Joseph Health CenterMadisonvilleTX6$233.00$81.55$139.80$198.05$233.00
Muleshoe Area Medical CenterMuleshoeTX4$245.00$147.00$96.00$196.00$245.00
Trinity Regional Hospital SachseSachseTX6$362.00$289.60$121.61$188.80$288.21
Wilson N Jones Regional Medical CtrShermanTX8$362.00$289.60$121.61$188.80$288.21
Hansford County Hospital DistrictSpearmanTX5$200.00$150.00$140.00$180.00$210.00
Ascension Seton Shoal CreekAustinTX7$20.23$153.33$162.17
Ascension Seton BastropBastropTX7$20.23$153.33$162.17
Methodist Hospital For SurgeryAddisonTX32$642.00$385.20$123.94$137.35$232.92
Acuity Hospital Of South TexasSan AntonioTX1$105.21$105.21$105.21
St Joseph Medical CenterHoustonTX0$1,189.42$1,189.42

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.