Reddenda · Rate Intelligence · Reading, PA
99204 under Highmark Blue Shield (PA) in Reading, PA
Office visit, new patient, 45-59 min · Local peer median $175.84 · High confidence
Local distribution · 205 providers · 217 rate records
- The local peer median for CPT 99204 under Highmark Blue Shield (PA) in Reading, PA is $175.84, drawn from 205 distinct providers.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Highmark Blue Shield (PA) to publish this rate
- The bottom of the local market (P10) is $140.67 and the top (P90) is $211.01; the median-to-P90 spread is $35.17.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Highmark Blue Shield (PA) to publish this rate
- The lowest published rate in this market is $36; the highest is $341.88.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Highmark Blue Shield (PA) to publish this rate
- This benchmark is drawn from 217 individual rate records that Highmark Blue Shield (PA) itself published for this code in this metro.Source: the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Highmark Blue Shield (PA) to publish this rate
- Medicare's national non-facility rate for CPT 99204 is $177.36, making the Highmark Blue Shield (PA) local median 99% of Medicare.Source: Medicare Physician Fee Schedule; the federal Transparency in Coverage Rule (45 CFR §147.212), which compels Highmark Blue Shield (PA) to publish this rate
- 19.8% 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 Highmark Blue Shield (PA) 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)
205 providers bill this code to this payer in this metro.
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This is the local market for CPT 99204 (Office visit, new patient, 45-59 min) under Highmark Blue Shield (PA) in Reading, PA. 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.
Documented reimbursement opportunity, modeled from published rates and never a guaranteed outcome.
Modeled from Highmark Blue Shield (PA)'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 Highmark Blue Shield (PA) to publish this rate. Page generated 2026-08-23 23:09 UTC; the live index is queried in real time on every request.