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Procedure price report · Consultation, evaluation, and preventative care

Specialist clinic consultation, high-complexity visit

CPT 99245the billing code this page is about

An office or outpatient consultation requested by another provider, at the highest level, involving a problem of high complexity and an extended period of physician time and decision-making.

Hospitals typically charge $298 cash for this outpatient procedure — the median across 904 hospitals that filed a usable cash price; the average of the middle 60% is $314. Most fall between $164 and $527 (20th–80th percentile).

Hospitals
904
States
48
Filings dated
Dec 2022 – Sep 2026
Computed
September 25, 2026
Prices checked
through September 24, 2026

Median: half of hospitals filed less, half more — and it is a price some hospital actually filed. Average of the middle 60%: the mean of the prices between the 20th and 80th percentiles. We never publish the plain average, the lowest or the highest price: the extremes in hospital price files are chargemaster artefacts, not prices anyone pays.

What hospitals charge, from cheapest to most expensive

Cash price percentiles, outpatient, across 904 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$109$187$298$470$660

The most expensive tenth of hospitals charges at least 6.1× what the cheapest tenth charges ($109 vs $660).

How the prices are spread

$80 – $101: 31 hospitals$80$101 – $127: 51 hospitals$127 – $161: 45 hospitals$127$161 – $203: 92 hospitals$203 – $256: 110 hospitals$203$256 – $322: 110 hospitals$322 – $407: 133 hospitals$322$407 – $513: 96 hospitals$513 – $647: 93 hospitals$513$647 – $816: 53 hospitals$647median $298price bands are equal on a log scale
Hospitals per price band (814 of 904 — the bands cover the 5th to 95th percentile)
FromToHospitals
$80$10131
$101$12751
$127$16145
$161$20392
$203$256110
$256$322110
$322$407133
$407$51396
$513$64793
$647$81653

By state

The median cash price in each state, against the national median of $298.

Alaska: median $681 across 10 hospitalsAK$681Maine: median $218 across 19 hospitalsME$218Vermont: median $404 across 10 hospitalsVT$404New Hampshire: 9 hospitals filed a usable price — fewer than 10, so no figureNHWashington: median $380 across 21 hospitalsWA$380Idaho: 3 hospitals filed a usable price — fewer than 10, so no figureIDMontana: median $430 across 15 hospitalsMT$430North Dakota: 6 hospitals filed a usable price — fewer than 10, so no figureNDMinnesota: median $341 across 43 hospitalsMN$341Illinois: median $283 across 38 hospitalsIL$283Wisconsin: median $400 across 54 hospitalsWI$400Michigan: median $227 across 39 hospitalsMI$227New York: median $444 across 55 hospitalsNY$444Massachusetts: median $289 across 12 hospitalsMA$289Oregon: median $381 across 12 hospitalsOR$381Nevada: 6 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 8 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 6 hospitals filed a usable price — fewer than 10, so no figureSDIowa: median $402 across 44 hospitalsIA$402Indiana: median $151 across 26 hospitalsIN$151Ohio: median $264 across 25 hospitalsOH$264Pennsylvania: median $280 across 43 hospitalsPA$280New Jersey: median $403 across 13 hospitalsNJ$403Connecticut: median $535 across 11 hospitalsCT$535Rhode Island: no hospital in the corpus filed a usable priceRICalifornia: median $256 across 41 hospitalsCA$256Utah: 2 hospitals filed a usable price — fewer than 10, so no figureUTColorado: median $324 across 17 hospitalsCO$324Nebraska: median $430 across 14 hospitalsNE$430Missouri: median $250 across 35 hospitalsMO$250Kentucky: median $145 across 17 hospitalsKY$145West Virginia: median $185 across 20 hospitalsWV$185Virginia: 6 hospitals filed a usable price — fewer than 10, so no figureVAMaryland: 4 hospitals filed a usable price — fewer than 10, so no figureMDDelaware: no hospital in the corpus filed a usable priceDEArizona: 9 hospitals filed a usable price — fewer than 10, so no figureAZNew Mexico: 4 hospitals filed a usable price — fewer than 10, so no figureNMKansas: median $301 across 25 hospitalsKS$301Arkansas: median $296 across 11 hospitalsAR$296Tennessee: 9 hospitals filed a usable price — fewer than 10, so no figureTNNorth Carolina: median $174 across 10 hospitalsNC$174South Carolina: median $288 across 17 hospitalsSC$288Oklahoma: median $189 across 20 hospitalsOK$189Louisiana: 7 hospitals filed a usable price — fewer than 10, so no figureLAMississippi: median $179 across 17 hospitalsMS$179Alabama: 9 hospitals filed a usable price — fewer than 10, so no figureALGeorgia: median $251 across 21 hospitalsGA$251Hawaii: median $227 across 11 hospitalsHI$227Texas: median $200 across 28 hospitalsTX$200Florida: median $515 across 22 hospitalsFL$515
Cash price by state, most expensive first. National median $298. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
Alaska AK10$681+128%$460 – $789
Connecticut CT11$535+79%$501 – $896
Florida FL22$515+73%$205 – $648
New York NY55$444+49%$169 – $627
Nebraska NE14$430+44%$374 – $586
Montana MT15$430+44%$119 – $567
Vermont VT10$404+35%$263 – $530
New Jersey NJ13$403+35%$238 – $1,077
Iowa IA44$402+35%$257 – $466
Wisconsin WI54$400+34%$240 – $532
Oregon OR12$381+28%$179 – $417
Washington WA21$380+27%$310 – $545
Minnesota MN43$341+14%$253 – $475
Colorado CO17$324+9%$171 – $507
Kansas KS25$301+1%$238 – $413
Arkansas AR11$296−1%$109 – $307
Massachusetts MA12$289−3%$162 – $583
South Carolina SC17$288−4%$228 – $733
Illinois IL38$283−5%$145 – $556
Pennsylvania PA43$280−6%$138 – $368
Ohio OH25$264−11%$173 – $529
California CA41$256−14%$110 – $494
Georgia GA21$251−16%$189 – $917
Missouri MO35$250−16%$165 – $351
Hawaii HI11$227−24%$181 – $267
Michigan MI39$227−24%$140 – $306
Maine ME19$218−27%$72 – $495
Texas TX28$200−33%$200 – $633
Oklahoma OK20$189−37%$164 – $296
West Virginia WV20$185−38%$93 – $322
Mississippi MS17$179−40%$99 – $280
North Carolina NC10$174−42%$148 – $341
Indiana IN26$151−49%$107 – $432
Kentucky KY17$145−51%$120 – $264
Alabama AL9not enough hospitals filed a usable price
Arizona AZ9not enough hospitals filed a usable price
New Hampshire NH9not enough hospitals filed a usable price
Tennessee TN9not enough hospitals filed a usable price
Wyoming WY8not enough hospitals filed a usable price
Louisiana LA7not enough hospitals filed a usable price
North Dakota ND6not enough hospitals filed a usable price
Nevada NV6not enough hospitals filed a usable price
South Dakota SD6not enough hospitals filed a usable price
Virginia VA6not enough hospitals filed a usable price
Maryland MD4not enough hospitals filed a usable price
New Mexico NM4not enough hospitals filed a usable price
Idaho ID3not enough hospitals filed a usable price
Utah UT2not enough hospitals filed a usable price

Hospitals like yours

The same distribution cut by the kind of hospital. Hospital type and ownership come from CMS; a hospital counts as part of a system when its price file is shared with at least one other hospital under the same brand. The national median is $298.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care534$272$157 – $531
Children’s30$476$248 – $877
Critical access338$333$179 – $502
Ownership
For-profit53$196$119 – $494
Government222$293$172 – $505
Non-profit627$308$165 – $540
System affiliation
Part of a system648$289$161 – $521
Independent256$310$174 – $529

Cash price vs list price

Median list price (chargemaster)$462
Median cash price$298
Cash as a share of list, median hospital69%

At the typical hospital, asking for the cash price cuts the list price by about 31%. The share is the median of each hospital’s own cash ÷ list ratio, over hospitals that filed both — not the ratio of the two medians above.

The same procedure, inpatient

532 hospitals filed a usable inpatient cash price for this code. The median is $302 and the average of the middle 60% is $314; most fall between $174 and $514.

Cash price percentiles, inpatient, across 532 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$127$189$302$451$655

The most expensive tenth of hospitals charges at least 5.1× what the cheapest tenth charges ($127 vs $655).

Of the 574 hospitals that filed this code inpatient, 532 gave a usable cash price; 2 carried a plausibility flag, 0 filed a number their own filing marks as not a price, 0 gave an estimate, and 40 a list price only.

How complete is this

904 of the 3,956 hospitals with a price file in our corpus (23%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 990 hospitals that filed this code at all gave us
Usable cash price — counted904
Cash price carrying a plausibility flag — shown on the compare tool, excluded here22
A number the filing itself marks as not a price (a placeholder, a ratio) — excluded0
An estimate rather than a filed cash price — excluded0
A list price only, no cash figure — excluded64
Hospitals that filed this code990

Sections not shown for this setting

  • Against Medicare: Medicare has no separately payable national outpatient (OPPS) rate for this code, so there is nothing honest to compare against.
  • Since our last snapshot: there is no earlier snapshot at least 90 days older than this one yet.

We last checked these hospitals’ price files for changes between July 20, 2026 and September 24, 2026; the figures were computed September 25, 2026 from filings loaded through September 24, 2026. The percentiles and averages use only the “counted” row.

Related procedures

Part of the Consultation, evaluation, and preventative care family.

Hospitals file this code under descriptions such as Office/OP Consltj New/Est Pt High Mdm 55 Minutes.

Method

Source
The machine-readable price files every U.S. hospital is required by CMS to publish, parsed per hospital. Nothing is surveyed, sampled or modelled.
What counts
One cash (self-pay) price per hospital for this code and setting. A hospital’s own filing can rule its number out — a placeholder, a “not applicable” note, a list price standing in for cash — and our plausibility checks can flag a price far below what every other hospital files. Both kinds are disclosed above and excluded from the statistics; on the compare tool a flagged price is still shown.
Statistics
Percentiles are discrete: each is a price some hospital filed. The average is the mean of the prices between the 20th and 80th percentiles. We never publish the plain mean, the minimum or the maximum. A state needs 10 hospitals and a segment 20 to show a figure; otherwise the row shows its count and no number. Medicare is the national unadjusted OPPS rate where one exists.
Names
Procedure names on these pages are our own plain-language titles, not the AMA’s copyrighted CPT descriptors. The code is the identity.

The full rules — sources, statistics, thresholds, limitations — are on the methodology page.

Download this page’s figures: JSON · CSV. Aggregates only — the per-hospital prices are on the compare tool.

Cite: HospitalRates.com, “Specialist clinic consultation, high-complexity visit (CPT 99245) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-99245-specialist-clinic-consultation-high-complexity-visit