HCPCS G0245 at Summit Pacific Medical Center

Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education

Summit Pacific Medical Center, Elma

Description from CMS's HCPCS Level II code file.

What Summit Pacific Medical Center publishes for this code: as an outpatient

Summit Pacific Medical Center’s prices for HCPCS G0245, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$105 – $1353 plans	$270
Medicare AdvantageInsurer rates	$37.50 – $39.753 plans	$35.04 – $37.14
Medicaid managed careInsurer rates	$34.65 – $38.123 plans	$150 – $165
Other government programInsurer rates	$37.501 plan	$35.04
UnknownInsurer rates	$34.65 – $1283 plans	$60.00 – $150
Cash pricePaying yourself, without insurance	$81.00	$81.00
List priceBefore any discount; few people pay it	$150	$150

Lowest and highest amounts Summit Pacific Medical Center lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-08-31. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for HCPCS G0245 at Summit Pacific Medical Center
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The clinic's facility fee, when the clinic belongs to the hospital	—	The price above
Doctor's visitThe doctor's practice	The visit itself	$35.04	$41.35 – $62.72

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare HCPCS G0245 at every Washington hospital, with Medicare’s reference amounts.