99204 Code – Should the cost be this high for new patient in network dermatologist?

I visited a dermatologist for the first time to get my acne checked out. I have the Blue Cross- AZ HDHP $3000. Sat and waited 15min after appointment time for him and talked to the dermatologist for maybe 20-25mins and got billed 99204 for 45-59mins ($860).

He honestly didn’t even give that much advice, I talked about my acne history, showed some pics and he said I had moderate to severe acne which I didn’t think it was that bad. He gave me 2 options, antibiotics or accutane and that was it. I picked accutane and filled out an ipledge and he prescribed 20mg for me and that was basically the whole interaction. He barely explained side effects to me (Dry skin, dry lips) besides handing me the paper.

To my surprise I just got a bill for $860 which came down to $700 after insurance, this was an in-network provider and I even looked up the cost estimate on mychart (portal to manage appointments, billing etc.) which said it should be $445 for this code. What can I do to change this? I’m a recent graduate that just started my job and I come from a low income family. I can’t afford this. I never would’ve gone if I had know it was going to cost this much. I feel so stupid for not calling to ask for an estimate and just checking online. I also had to do a blood work which was $150 (originally $300) after insurance.

I’m feeling really shocked and anxious about having to pay this. It’s also been 2 weeks and I haven’t been able to pick up my medication because they took a week to fill out my prior authorization form (had to call them and ask) and insurance needs to review it. I’m supposed to have a follow up with him in 2 weeks to see how I am reacting to accutane. Should I stop seeing this dermatologist and look for an online option? I did some research and it’s so much cheaper (Skymd $79)

TLDR: billed $860 for new patient in network provider (UCSF) dermatologist visit (99204), estimate said $445 on their portal. Kind of anxious and depressed about racking up such a high bill when I just started a new grad job living in San Francisco. Anything I can do to negotiate this? Should I find another dermatologist or just rack up bills till I hit my $3000 deductible with ($1,100 employer HSA)? Any advice greatly appreciated.