Office visits · procedure code 99204
Longer new patient visit cost in Sacramento, CA
What health plans have contracted to pay providers for Office visit, new patient, 45 to 59 minutes in the Sacramento-Roseville-Folsom market, from the machine-readable files those plans publish under federal law. Not billed charges, and not an estimate.
Metro market
Longer new patient visit
Sacramento-Roseville-Folsom, CA · procedure code 99204
Middle price
$169
Half of this market is above it, half below
Middle half spans
$135 to $579
4.3x from low to high
The expensive end
$648
What the priciest providers charge
Medicare reference · Sacramento-Roseville-Folsom
$190
Performed in an office
$120
Physician fee in a facility
Read this carefully. The facility figure is the physician fee only. When the same service happens in a hospital outpatient department, the hospital bills its own facility payment on top, and that amount is not in this dataset. So the lower number here does not mean the hospital is the cheaper site. It usually is not. We will not publish a total cost by site of service until we hold the facility payment.
Negotiated prices from published filings, reported only where the sample supports it. For your city, not a statewide average. What plans have agreed to pay, not what a patient is billed. Filings as of July 20, 2026.
Reading it
What this distribution actually says.
The spread
The middle half of this market runs from $135 to $579, a 4.3x difference for the same procedure code in the same city. That gap is between contracts, not between quality.
Against Medicare
The middle price sits at 89% of what Medicare pays for the same service at its Sacramento-Roseville-Folsom locality. Medicare is a fixed reference line most finance teams already have a feel for, which is why we print it beside every figure. It is not a fair price and not what anything should cost.
The expensive end
One in ten filings sits at or above $648. If a plan's network is weighted toward that end, the difference does not show up in a premium quote. It shows up in the claims.
How wide the data runs
The carriers that filed for this procedure in this market. What each plan has agreed to pay, side by side. These are prices, not bills, so they do not show how often anyone needs it.
The same service elsewhere
Longer new patient visit across other markets.
Of the 6 markets compared here, Sacramento, CA has the 5th highest middle price.
Put this in front of a client.
Every figure on this page carries its source, its scope and the date the corpus was built, so it survives being forwarded to someone who was not in the meeting.