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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
Median
$259.5
Max
$3,840
Range multiplier
48.0×

By payer (50 payers with published rates)

PayerHosp.RatesMinMedianMaxRange×
Blue Cross Blue Shield38178$47$274.53$8,427179.3×
UnitedHealthcare3384$20.23$198.32$687.9634.0×
Aetna2370$68.89$257.34$641.29.3×
Humana1640$88.31$380.36$705.68.0×
Cigna1834$55.11$251.15$1,80032.7×
Medicaid1123$1$170.52$704704.0×
Anthem BCBS222$114.67$162.17$162.171.4×
Multiplan1721$198.05$441.7$778.63.9×
First Health1217$242$661.5$732.83.0×
healthsmart715$64$784.98$784.9812.3×
commercial | galaxy | all plans912$520.2$521.55$567.91.1×
commercial | phcs | all plans58$198.05$392.18$425.932.2×
assurant health48$582.12$582.12$582.121.0×
web tpa48$396.9$396.9$396.91.0×
superior health plan36$145$202.87$3132.2×
scott & white56$264.6$264.6$650.362.5×
commercial | nppn | all plans55$489.6$489.6$489.61.0×
Medicare15$124.61$137.35$138.661.1×
wellmed25$65$70.38$248.483.8×
commercial | usa health network | all plans55$520.2$520.2$520.21.0×
galaxy health network35$80$284$633.67.9×
pphp14$90.07$139.62$173.311.9×
commercial | healthsmart | ppo44$428.4$428.4$428.41.0×
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$122.6$122.6$122.61.0×
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$6871.4×
prime health services13$544$709$1,1702.2×
friday health insurance company13$1,088$1,417$2,3402.2×
oscar13$167$218$3602.2×
phcs12$687$687$6871.0×
commercial | healthsmart | all plans22$428.4$428.4$428.41.0×
commercial | health first | all plans12$306$312$3181.0×
commercial | firstcare | all plans22$139.8$139.8$139.81.0×
health partners open network22$214.84$214.84$214.841.0×
health industry trust and welfare plan12$418.77$526.19$633.61.5×
accountable health plans of america12$395.51$496.96$598.41.5×
galaxy health12$888.52$888.52$888.521.0×
Molina22$168.87$244.74$320.61.9×
choicecare network ppo, pos, med adv12$372.24$467.72$563.21.5×
methodist12$521.66$521.66$521.661.0×
choice one inc ppo12$372.24$467.72$563.21.5×
imagine health12$641.2$641.2$641.21.0×
great west healthcare of texas12$409.46$514.49$619.521.5×
equifax healthcare12$778.6$778.6$778.61.0×
choice one inc epo/pos12$335.02$420.95$506.881.5×
medavant healthcare solutions12$372.24$467.72$563.21.5×
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$235$64$82$108
BAYLOR COUNTY HOSPITAL DISTRICTSEYMOURTX9$434$303.8$65$80$263.08
CRESCENT MEDICAL CENTER LANCASTERLANCASTERTX5$1,800$1,170$167$709$2,340
CHILDRENS MEDICAL CENTER OF PLANOPLANOTX31$916$687$144.29$641.2$888.52
SAN ANGELO COMMUNITY MEDICAL CENTERSAN ANGELOTX11$882$441$122.6$635.04$784.98
SHANNON MEDICAL CENTERSAN ANGELOTX11$882$441$122.6$635.04$784.98
BIG SPRING STATE HOSPITALBIG SPRINGSTX11$882$441$122.6$635.04$784.98
RIVER CREST HOSPITALSAN ANGELOTX11$882$441$122.6$635.04$784.98
DRISCOLL CHILDRENS HOSPITALCORPUS CHRISTITX2$1,230.9$246.18$165.82$582.91$1,000
DIMMIT REGIONAL HOSPITAL DISTRICTCARRIZO SPRINGSTX3$640$384$171$432$614
RICE MEDICAL CENTEREAGLE LAKETX19$704$492.8$1$409.46$704
ST LUKES HEALTH MEMORIAL SAN AUGUSTSAN AUGUSTINETX7$631$220.85$47$407.48$567.9
CHI ST LUKES HEALTH MEM LIVINGSTONLIVINGSTONTX6$631$220.85$47$391.89$567.9
CHI ST LUKES HEALTH MEMORIAL LUFKINLUFKINTX7$631$220.85$47$391.89$567.9
BAYLOR ORTHOPEDIC AND SPINE HOSPITALARLINGTONTX1$1,820$3,840$8,427
ST. LUKES PATIENTS MEDICAL CENTERPASADENATX6$612$214.2$184.96$330.57$520.2
ST. LUKES LAKESIDE HOSPITALTHE WOODLANDSTX9$612$214.2$98$321.33$520.2
ST. LUKES SUGAR LAND HOSPITALSUGAR LANDTX9$612$214.2$98$321.33$520.2
ST. LUKES THE WOODLANDS HOSPITALTHE WOODLANDSTX9$612$214.2$98$321.33$520.2
ST LUKES HOSPITAL AT THE VINTAGEHOUSTONTX9$612$214.2$98$321.33$520.2
BRAZOSPORT REGIONAL HEALTH SYSTEMLAKE JACKSONTX2$636$222.6$273.21$318$367.78
CHI ST LUKES HEALTH BAYLOR MED CTRHOUSTONTX10$612$214.2$99$282.4$520.2
MCCAMEY COUNTY HOSPITAL DISTRICTMCCAMEYTX14$316$316$190$278$316
EASTLAND MEMORIAL HOSPITALEASTLANDTX3$363$182$225$259.5$327
NORTH TEXAS MEDICAL CENTERGAINSVILLETX9$403$101$131$242$371
HERITAGE PARK SURGICAL HOSPITALSHERMANTX1$162$97.2$238.44$238.44$238.44
CRANE COUNTY HOSPITAL DISTRICTCRANETX2$389$272$226$237$350
LIMESTONE MEDICAL CENTERGROESBECKTX8$585.9$351.54$88.31$235.99$468.72
ST. JOSEPH REGIONAL HEALTH CENTERBRYANTX3$233$81.55$173$214.62$233
COLLEGE STATION MEDICAL CENTERCOLLEGE STATIONTX3$233$81.55$173$214.62$233
GRIMES ST. JOSEPH HEALTH CENTERNAVASOTATX3$233$81.55$173$214.62$233
FALLS COMMUNITY HOSPITAL AND CLINICMARLINTX6$405$324$65$214.55$590.31
BURLESON ST. JOSEPH HEALTH CENTERCALDWELLTX5$233$81.55$139.8$203.88$233
GOLDEN PLAINS COMMUNITY HOSPITALBORGERTX6$599$419.3$55.11$198.9$407.32
MADISON ST. JOSEPH HEALTH CENTERMADISONVILLETX6$233$81.55$139.8$198.05$233
MULESHOE AREA MEDICAL CENTERMULESHOETX4$245$147$96$196$245
TRINITY REGIONAL HOSPITAL SACHSESACHSETX6$362$289.6$121.61$188.8$288.21
WILSON N JONES REGIONAL MEDICAL CTRSHERMANTX8$362$289.6$121.61$188.8$288.21
HANSFORD COUNTY HOSPITAL DISTRICTSPEARMANTX5$200$150$140$180$210
ASCENSION SETON SHOAL CREEKAUSTINTX7$20.23$153.33$162.17
ASCENSION SETON BASTROPBASTROPTX7$20.23$153.33$162.17
METHODIST HOSPITAL FOR SURGERYADDISONTX32$642$385.2$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.