Price Checker / CPT 99204
How much does New patient office visit — detailed cost?
CPT 99204 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is in line with what this normally costs. No need to dispute.
Fair price
$390–$460
What this should cost
With insurance
~$400,700
Typical out-of-pocket
Overcharged if over
$580
Push back above this
The average hospital charge of $438 is $8 over the fair price.
What hospitals charge for New patient office visit — detailed
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Bladen County Hospital , NC | $406 | — | 4311% |
| Hoke Hospital , NC | $406 | — | 4311% |
| Columbus Springs Dublin , OH | $2,921 | — | 1547% |
| Rainier Springs VANCOUVER, WA | $225 | — | 670% |
| Denver Springs Changes ENGLEWOOD, CO | $225 | — | 577% |
| Denver Springs ENGLEWOOD, 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% |
| EHHS Milton Clinic Medicare , WI | $335 | $245 | 89% |
| Lindner Center of Hope MASON, OH | $340 | — | 84% |
| Pine Rest Christian Mental Health Services GRAND RAPIDS, MI | $306 | $245 | 73% |
| Aspire Health Partners, Inc Orlando, FL | $180 | — | 46% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About New patient office visit — detailed
CPT code 99204 refers to new patient office visit — detailed (billing description: "Office o/p new mod 45 min"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $117 in a facility (hospital or surgery center) and $177 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.