HRHospitalRates.comCompare prices

Procedure price report · Consultation, evaluation, and preventative care

Doctor-led care management for one illness, extra 30 minutes

CPT 99425the billing code this page is about

Add-on to monthly provider-performed care management for a single serious condition; one unit equals each additional 30 minutes in the month.

Hospitals typically charge $91 cash for this outpatient procedure — the median across 158 hospitals that filed a usable cash price; the average of the middle 60% is $91. Most fall between $58 and $134 (20th–80th percentile).

Hospitals
158
States
34
Filings dated
Sep 2024 – 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 158 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
$35$60$91$133$169

The most expensive tenth of hospitals charges at least 4.8× what the cheapest tenth charges ($35 vs $169).

How the prices are spread

$31 – $39: 14 hospitals$31$39 – $48: 1 hospitals$48 – $59: 14 hospitals$48$59 – $73: 28 hospitals$73 – $90: 13 hospitals$73$90 – $112: 20 hospitals$112 – $138: 31 hospitals$112$138 – $170: 15 hospitals$170 – $211: 2 hospitals$170$211 – $260: 12 hospitals$211median $91price bands are equal on a log scale
Hospitals per price band (150 of 158 — the bands cover the 5th to 95th percentile)
FromToHospitals
$31$3914
$39$481
$48$5914
$59$7328
$73$9013
$90$11220
$112$13831
$138$17015
$170$2112
$211$26012

By state

The median cash price in each state, against the national median of $91.

Alaska: no hospital in the corpus filed a usable priceAKMaine: 2 hospitals filed a usable price — fewer than 10, so no figureMEVermont: no hospital in the corpus filed a usable priceVTNew Hampshire: 1 hospital filed a usable price — fewer than 10, so no figureNHWashington: 3 hospitals filed a usable price — fewer than 10, so no figureWAIdaho: 1 hospital filed a usable price — fewer than 10, so no figureIDMontana: 4 hospitals filed a usable price — fewer than 10, so no figureMTNorth Dakota: 1 hospital filed a usable price — fewer than 10, so no figureNDMinnesota: 4 hospitals filed a usable price — fewer than 10, so no figureMNIllinois: median $100 across 10 hospitalsIL$100Wisconsin: median $133 across 16 hospitalsWI$133Michigan: median $96 across 21 hospitalsMI$96New York: median $57 across 10 hospitalsNY$57Massachusetts: 4 hospitals filed a usable price — fewer than 10, so no figureMAOregon: median $126 across 10 hospitalsOR$126Nevada: 2 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 2 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 1 hospital filed a usable price — fewer than 10, so no figureSDIowa: 4 hospitals filed a usable price — fewer than 10, so no figureIAIndiana: 5 hospitals filed a usable price — fewer than 10, so no figureINOhio: median $99 across 11 hospitalsOH$99Pennsylvania: median $33 across 10 hospitalsPA$33New Jersey: 1 hospital filed a usable price — fewer than 10, so no figureNJConnecticut: no hospital in the corpus filed a usable priceCTRhode Island: no hospital in the corpus filed a usable priceRICalifornia: 6 hospitals filed a usable price — fewer than 10, so no figureCAUtah: no hospital in the corpus filed a usable priceUTColorado: no hospital in the corpus filed a usable priceCONebraska: 6 hospitals filed a usable price — fewer than 10, so no figureNEMissouri: 2 hospitals filed a usable price — fewer than 10, so no figureMOKentucky: 3 hospitals filed a usable price — fewer than 10, so no figureKYWest Virginia: 2 hospitals filed a usable price — fewer than 10, so no figureWVVirginia: no hospital in the corpus filed a usable priceVAMaryland: 1 hospital filed a usable price — fewer than 10, so no figureMDDelaware: no hospital in the corpus filed a usable priceDEArizona: 1 hospital filed a usable price — fewer than 10, so no figureAZNew Mexico: no hospital in the corpus filed a usable priceNMKansas: 4 hospitals filed a usable price — fewer than 10, so no figureKSArkansas: no hospital in the corpus filed a usable priceARTennessee: 4 hospitals filed a usable price — fewer than 10, so no figureTNNorth Carolina: no hospital in the corpus filed a usable priceNCSouth Carolina: no hospital in the corpus filed a usable priceSCOklahoma: no hospital in the corpus filed a usable priceOKLouisiana: 1 hospital filed a usable price — fewer than 10, so no figureLAMississippi: no hospital in the corpus filed a usable priceMSAlabama: no hospital in the corpus filed a usable priceALGeorgia: no hospital in the corpus filed a usable priceGAHawaii: 1 hospital filed a usable price — fewer than 10, so no figureHITexas: 1 hospital filed a usable price — fewer than 10, so no figureTXFlorida: 3 hospitals filed a usable price — fewer than 10, so no figureFL
Cash price by state, most expensive first. National median $91. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
Wisconsin WI16$133+45%$133 – $133
Oregon OR10$126+38%$92 – $126
Illinois IL10$100+10%$58 – $169
Ohio OH11$99+9%$99 – $260
Michigan MI21$96+5%$61 – $114
New York NY10$57−38%$28 – $125
Pennsylvania PA10$33−64%$27 – $37
California CA6not enough hospitals filed a usable price
Nebraska NE6not enough hospitals filed a usable price
Indiana IN5not enough hospitals filed a usable price
Iowa IA4not enough hospitals filed a usable price
Kansas KS4not enough hospitals filed a usable price
Massachusetts MA4not enough hospitals filed a usable price
Minnesota MN4not enough hospitals filed a usable price
Montana MT4not enough hospitals filed a usable price
Tennessee TN4not enough hospitals filed a usable price
Florida FL3not enough hospitals filed a usable price
Kentucky KY3not enough hospitals filed a usable price
Washington WA3not enough hospitals filed a usable price
Maine ME2not enough hospitals filed a usable price
Missouri MO2not enough hospitals filed a usable price
Nevada NV2not enough hospitals filed a usable price
West Virginia WV2not enough hospitals filed a usable price
Wyoming WY2not enough hospitals filed a usable price
Arizona AZ1not enough hospitals filed a usable price
Hawaii HI1not enough hospitals filed a usable price
Idaho ID1not enough hospitals filed a usable price
Louisiana LA1not enough hospitals filed a usable price
Maryland MD1not enough hospitals filed a usable price
North Dakota ND1not enough hospitals filed a usable price
New Hampshire NH1not enough hospitals filed a usable price
New Jersey NJ1not enough hospitals filed a usable price
South Dakota SD1not enough hospitals filed a usable price
Texas TX1not 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 $91.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care99$96$58 – $145
Children’s3fewer than 20 hospitals
Critical access55$92$58 – $133
Ownership
For-profit15fewer than 20 hospitals
Government22$99$67 – $154
Non-profit120$91$58 – $133
System affiliation
Part of a system117$82$58 – $133
Independent41$96$62 – $149

Cash price vs list price

Median list price (chargemaster)$153
Median cash price$91
Cash as a share of list, median hospital65%

At the typical hospital, asking for the cash price cuts the list price by about 35%. 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

100 hospitals filed a usable inpatient cash price for this code. The median is $83 and the average of the middle 60% is $93; most fall between $57 and $133.

Cash price percentiles, inpatient, across 100 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
$36$58$83$128$133

The most expensive tenth of hospitals charges at least 3.7× what the cheapest tenth charges ($36 vs $133).

Of the 103 hospitals that filed this code inpatient, 100 gave a usable cash price; 1 carried a plausibility flag, 0 filed a number their own filing marks as not a price, 0 gave an estimate, and 2 a list price only.

How complete is this

158 of the 3,956 hospitals with a price file in our corpus (4%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 161 hospitals that filed this code at all gave us
Usable cash price — counted158
Cash price carrying a plausibility flag — shown on the compare tool, excluded here0
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 — excluded3
Hospitals that filed this code161

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 September 4, 2026 and September 24, 2026; the figures were computed September 25, 2026 from filings loaded through September 23, 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 PRIN CARE MGMT PHYS EA ADDL.

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, “Doctor-led care management for one illness, extra 30 minutes (CPT 99425) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-99425-doctor-led-care-management-for-one-illness-extra-30-minutes