What is the top of the local market (P90) for CPT 99204 under Bcbstx for Philadelphia-Camden-Wilmington, PA-NJ-DE-MD providers?

The P90, the top of the local market and Reddenda's target rate, is $220.

How does Bcbstx's rate for CPT 99204 compare to Medicare?

The Bcbstx local median of $169.39 is 96% of Medicare's national non-facility rate of $177.36 for CPT 99204.

Reddenda · Rate Intelligence · Philadelphia-Camden-Wilmington, PA-NJ-DE-MD

99204 under Bcbstx, for Philadelphia-Camden-Wilmington, PA-NJ-DE-MD providers

Name: Bcbstx rates for CPT 99204 among Philadelphia-Camden-Wilmington, PA-NJ-DE-MD providers
Creator: Reddenda

Office visit, new patient, 45-59 min · Local peer median $169.39 · High confidence

$169.39 local peer median. Bcbstx's published rate file lists a local peer median of $169.39 for CPT 99204 (Office visit, new patient, 45-59 min) among 1301 indexed providers in Philadelphia-Camden-Wilmington, PA-NJ-DE-MD. Where a Blue Cross entity’s label carries a state, that state names the file we found the rate in, not the provider’s location. Blue Cross plans file separately per state and do not share rates, even for the same provider. The top of that filed distribution, the P90 target, is $220, 30% above the median. A provider billed below this median is being paid less than peers holding the identical Bcbstx contract for the identical code. Modeled from published rates, not guaranteed.

Local distribution · 1301 providers · 2162 rate records

P10

$103.52

P25

$149.46

Median

$169.39

P75

$175.84

P90 (target)

$220

P10$103.52

P25$149.46

Median (P50)$169.39

P75$175.84

P90 target$220

Peer basis: local peer distribution: same CPT, same payer file, same metro (CBSA) Benchmark: local peer median; never a national average Range: $36 – $1,332

The local peer median for CPT 99204 under Bcbstx for Philadelphia-Camden-Wilmington, PA-NJ-DE-MD providers is $169.39, drawn from 1301 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
The bottom of the local market (P10) is $103.52 and the top (P90) is $220; the median-to-P90 spread is $50.61.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
The lowest published rate in this market is $36; the highest is $1,332.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
This benchmark is drawn from 2162 individual rate records that Bcbstx itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
Medicare's national non-facility rate for CPT 99204 is $177.36, making the Bcbstx local median 96% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
20.5% of indexed providers cluster at the single most common rate; the remainder shows a real, scoreable spread across the local market.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate
A federal No Surprises Act arbitrator may weigh up to four plan years of a provider's own contracted rate history and local market share when resolving a payment dispute over this exact code and payer.Source: 45 CFR §149.510(c)(4)(iii)(B)

1301 providers bill this code to this payer in this metro.

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These are the rates Bcbstx publishes for CPT 99204 (Office visit, new patient, 45-59 min) among Philadelphia-Camden-Wilmington, PA-NJ-DE-MD providers. Enter your NPI to see your own contracted rate against this peer curve, per payer and per code. Free, about 15 seconds, no card and no PHI.

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Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.

Modeled from Bcbstx's own published in-network rates, never guaranteed and never a national average. Peer basis: same CPT, same payer file, same metro (CBSA). Federal citation for the underlying obligation: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Bcbstx to publish this rate. Page generated 2026-08-23 22:48 UTC; the live index is queried in real time on every request.