Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC VISIT NEW PATIENT LEVEL 4
Low
$114
Average
$244
Median
$189
High
$1.1k
Each hospital's average Premera rate, under the methodology and billing class chosen below.
49 hospitals; the 90th percentile is 2.0× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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79 hospital rates
iThe hospitals that file a Premera rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Seattle Children's Hospital Seattle, WA professional · fee schedule · both | 3 | $289 | $289 | — | — | 1,150 | $289 – $289 |
| 2 | Saint Francis Hospital and Medical Center Hartford, CT professional · fee schedule · both | 1 | $253 | $253 | — | — | 78 | $253 – $253 |
| 3 | Saint Alphonsus Regional Medical Center - Boise Boise, ID professional · fee schedule · both | 1 | $339 | $339 | — | — | 73–82 | $339 – $339 |
| 4 | Saint Alphonsus Medical Center - Nampa Nampa, ID professional · fee schedule · both | 1 | $270 | $270 | — | — | 43 | $270 – $270 |
| 5 | Mercy Health Saint Marys Rockford, MI professional · fee schedule · outpatient | 1 | $179 | $179 | — | — | 38–47 | $179 – $179 |
| 6 | St Mary Mercy Livonia Livonia, MI professional · fee schedule · outpatient | 1 | $179 | $179 | — | — | 13–22 | $179 – $179 |
| 7 | Catholic Health Initiatives-Iowa Corp Des Moines, IA professional · fee schedule · both | 1 | $189 | $189 | — | — | 12–21 | $189 – $189 |
| 8 | Mishawaka Medical Center Mishawaka, IN professional · fee schedule · outpatient | 1 | $190 | $190 | — | — | 12–21 | $190 – $190 |
| 9 | Public Hospital Dis No 1 Skagit dba Skagit Valley Hospital Vernon, WA fee schedule · outpatient | 1 | $327 | $327 | — | — | 3–30 | $327 – $327 |
| 10 | Mercy Health Lakeshore Campus Shelby, MI professional · fee schedule · outpatient | 1 | $152 | $152 | — | — | 2–20 | $152 – $152 |
| 11 | Mount Carmel Dublin Dublin, OH professional · percent of total billed charges · outpatientfrom % of charges | 1 | $285 | $285 | — | — | 2–20 | $285 – $285 |
| 12 | Samaritan Hospital Troy, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $425 | $425 | — | — | 2–20 | $425 – $425 |
| 13 | St Peters Hospital Albany, NY professional · percent of total billed charges · bothfrom % of charges | 1 | $425 | $425 | — | — | 2–20 | $425 – $425 |
| 14 | St. Francis Hospital Inc Wilmington, DE professional · fee schedule · outpatient | 1 | $144 | $144 | — | — | 2–20 | $144 – $144 |
| 15 | The Mercy Hospital Inc Springfield, MA professional · fee schedule · both | 1 | $218 | $218 | — | — | 2–20 | $218 – $218 |
| 16 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL professional · fee schedule · both | 1 | $186 | $186 | — | — | 1–10 | $186 – $186 |
| 17 | Holy Cross Hospital-Silver Spring Silver Spring, MD professional · percent of total billed charges · bothfrom % of charges | 1 | $285 | $285 | — | — | 1–10 | $285 – $285 |
| 18 | Mercy Health Hackley Campus Muskogen, MI professional · fee schedule · outpatient | 1 | $152 | $152 | — | — | 1–10 | $152 – $152 |
| 19 | Saint Alphonsus Medical Center - Ontario Ontario, OR professional · fee schedule · both | 1 | $270 | $270 | — | — | 1–10 | $270 – $270 |
| 20 | St Joseph Mercy Chelsea Chelsea, MI professional · fee schedule · both | 1 | $179 | $179 | — | — | 1–10 | $179 – $179 |
| 21 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA professional · fee schedule · inpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 22 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA professional · fee schedule · outpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 23 | Central Community Hospital Elkader, IA professional · fee schedule · inpatient | 1 | $189 | $189 | — | — | — | $189 – $189 |
| 24 | Central Community Hospital Elkader, IA professional · fee schedule · outpatient | 1 | $203 | $203 | — | — | — | $203 – $203 |
| 25 | Central Washington Health Services Association Wenatchee, WA fee schedule · inpatient | 5 | $283 | $263 | $32 | 12% | — | $188 – $283 |
← Payers reporting CPT 99204 · Snapshot 20261111T120946Z-9134e7f7