Price Checker / CPT 99204
CPT 99204 — Office o/p new mod 45 min
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$117
What Medicare pays in a hospital/ASC setting
$177
What Medicare pays in a physician's office
$1,339
Based on 24 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 99204
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Dominican Hospital Santa Cruz, CA | $252 | — | 563724% |
| McLaren Port Huron , MI | $22,434 | $11,217 | 12549% |
| Bladen County Hospital , NC | $406 | — | 4311% |
| Hoke Hospital , NC | $406 | — | 4311% |
| Columbus Springs Dublin , OH | $2,921 | — | 1547% |
| Rainier Springs , WA | $225 | — | 670% |
| Denver Springs Changes , CO | $225 | — | 577% |
| Denver Springs , CO | $225 | — | 577% |
| Copper Springs , AZ | $225 | — | 569% |
| UPMC Western Psychiatric , PA | $594 | $475 | 235% |
| Northeast Texas Rural Health Clinic Mt. Pleasant, TX | $481 | — | 117% |
| Pennsylvania Psychiatric Institute Harrisburg, PA | $456 | — | 106% |
| Mackinac Straits Health System Saint Ignace, MI | $395 | — | 104% |
| RCG Taft Street , IN | $350 | $350 | 97% |
| Lindner Center of Hope , OH | $340 | $201 | 92% |
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About CPT 99204
CPT code 99204 refers to “Office o/p new mod 45 min”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $117 in a facility (hospital or ambulatory surgery center) and $177in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.