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Procedure price report · Consultation, evaluation, and preventative care

Hospital specialist consultation, high-complexity visit

CPT 99255the billing code this page is about

A first consultation by a specialist for a patient who is admitted or under observation, at the highest level, involving a problem of high complexity and an extended period of physician time and decision-making.

Hospitals typically charge $345 cash for this outpatient procedure — the median across 642 hospitals that filed a usable cash price; the average of the middle 60% is $357. Most fall between $211 and $534 (20th–80th percentile).

Hospitals
642
States
49
Filings dated
Dec 2023 – 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 642 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
$138$232$345$495$661

The most expensive tenth of hospitals charges at least 4.8× what the cheapest tenth charges ($138 vs $661).

How the prices are spread

$107 – $130: 23 hospitals$107$130 – $159: 27 hospitals$159 – $195: 33 hospitals$159$195 – $239: 58 hospitals$239 – $292: 77 hospitals$239$292 – $357: 86 hospitals$357 – $437: 108 hospitals$357$437 – $535: 86 hospitals$535 – $654: 49 hospitals$535$654 – $800: 35 hospitals$654median $345price bands are equal on a log scale
Hospitals per price band (582 of 642 — the bands cover the 5th to 95th percentile)
FromToHospitals
$107$13023
$130$15927
$159$19533
$195$23958
$239$29277
$292$35786
$357$437108
$437$53586
$535$65449
$654$80035

By state

The median cash price in each state, against the national median of $345.

Alaska: 9 hospitals filed a usable price — fewer than 10, so no figureAKMaine: median $450 across 20 hospitalsME$450Vermont: median $420 across 11 hospitalsVT$420New Hampshire: 8 hospitals filed a usable price — fewer than 10, so no figureNHWashington: median $388 across 18 hospitalsWA$388Idaho: 3 hospitals filed a usable price — fewer than 10, so no figureIDMontana: median $295 across 14 hospitalsMT$295North Dakota: 3 hospitals filed a usable price — fewer than 10, so no figureNDMinnesota: median $417 across 34 hospitalsMN$417Illinois: median $375 across 38 hospitalsIL$375Wisconsin: median $534 across 34 hospitalsWI$534Michigan: median $270 across 39 hospitalsMI$270New York: median $336 across 26 hospitalsNY$336Massachusetts: 3 hospitals filed a usable price — fewer than 10, so no figureMAOregon: 8 hospitals filed a usable price — fewer than 10, so no figureORNevada: 4 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 6 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 3 hospitals filed a usable price — fewer than 10, so no figureSDIowa: median $366 across 36 hospitalsIA$366Indiana: median $187 across 24 hospitalsIN$187Ohio: median $428 across 22 hospitalsOH$428Pennsylvania: median $164 across 22 hospitalsPA$164New Jersey: 1 hospital filed a usable price — fewer than 10, so no figureNJConnecticut: 6 hospitals filed a usable price — fewer than 10, so no figureCTRhode Island: 2 hospitals filed a usable price — fewer than 10, so no figureRICalifornia: median $253 across 22 hospitalsCA$253Utah: 2 hospitals filed a usable price — fewer than 10, so no figureUTColorado: median $345 across 14 hospitalsCO$345Nebraska: median $367 across 12 hospitalsNE$367Missouri: median $286 across 23 hospitalsMO$286Kentucky: median $239 across 13 hospitalsKY$239West Virginia: median $208 across 14 hospitalsWV$208Virginia: 6 hospitals filed a usable price — fewer than 10, so no figureVAMaryland: 3 hospitals filed a usable price — fewer than 10, so no figureMDDelaware: no hospital in the corpus filed a usable priceDEArizona: 5 hospitals filed a usable price — fewer than 10, so no figureAZNew Mexico: 1 hospital filed a usable price — fewer than 10, so no figureNMKansas: median $281 across 18 hospitalsKS$281Arkansas: 5 hospitals filed a usable price — fewer than 10, so no figureARTennessee: median $148 across 11 hospitalsTN$148North Carolina: 5 hospitals filed a usable price — fewer than 10, so no figureNCSouth Carolina: 7 hospitals filed a usable price — fewer than 10, so no figureSCOklahoma: median $232 across 15 hospitalsOK$232Louisiana: 3 hospitals filed a usable price — fewer than 10, so no figureLAMississippi: 6 hospitals filed a usable price — fewer than 10, so no figureMSAlabama: 6 hospitals filed a usable price — fewer than 10, so no figureALGeorgia: median $266 across 16 hospitalsGA$266Hawaii: 8 hospitals filed a usable price — fewer than 10, so no figureHITexas: median $370 across 22 hospitalsTX$370Florida: median $509 across 11 hospitalsFL$509
Cash price by state, most expensive first. National median $345. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
Wisconsin WI34$534+55%$402 – $800
Florida FL11$509+48%$300 – $1,104
Maine ME20$450+31%$127 – $694
Ohio OH22$428+24%$221 – $648
Vermont VT11$420+22%$297 – $618
Minnesota MN34$417+21%$320 – $705
Washington WA18$388+12%$303 – $577
Illinois IL38$375+9%$260 – $628
Texas TX22$370+7%$251 – $498
Nebraska NE12$367+6%$332 – $492
Iowa IA36$366+6%$324 – $460
Colorado CO14$3450%$198 – $498
New York NY26$336−3%$180 – $488
Montana MT14$295−14%$219 – $500
Missouri MO23$286−17%$200 – $368
Kansas KS18$281−18%$236 – $371
Michigan MI39$270−22%$216 – $341
Georgia GA16$266−23%$193 – $419
California CA22$253−27%$121 – $491
Kentucky KY13$239−31%$135 – $279
Oklahoma OK15$232−33%$232 – $363
West Virginia WV14$208−40%$191 – $333
Indiana IN24$187−46%$119 – $441
Pennsylvania PA22$164−53%$126 – $378
Tennessee TN11$148−57%$107 – $152
Alaska AK9not enough hospitals filed a usable price
Hawaii HI8not enough hospitals filed a usable price
New Hampshire NH8not enough hospitals filed a usable price
Oregon OR8not enough hospitals filed a usable price
South Carolina SC7not enough hospitals filed a usable price
Alabama AL6not enough hospitals filed a usable price
Connecticut CT6not enough hospitals filed a usable price
Mississippi MS6not enough hospitals filed a usable price
Virginia VA6not enough hospitals filed a usable price
Wyoming WY6not enough hospitals filed a usable price
Arkansas AR5not enough hospitals filed a usable price
Arizona AZ5not enough hospitals filed a usable price
North Carolina NC5not enough hospitals filed a usable price
Nevada NV4not enough hospitals filed a usable price
Idaho ID3not enough hospitals filed a usable price
Louisiana LA3not enough hospitals filed a usable price
Massachusetts MA3not enough hospitals filed a usable price
Maryland MD3not enough hospitals filed a usable price
North Dakota ND3not enough hospitals filed a usable price
South Dakota SD3not enough hospitals filed a usable price
Rhode Island RI2not enough hospitals filed a usable price
Utah UT2not enough hospitals filed a usable price
New Jersey NJ1not enough hospitals filed a usable price
New Mexico NM1not 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 $345.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care353$312$183 – $507
Children’s19fewer than 20 hospitals
Critical access269$378$231 – $563
Ownership
For-profit37$239$135 – $445
Government170$348$223 – $509
Non-profit434$355$215 – $536
System affiliation
Part of a system439$345$198 – $534
Independent203$343$223 – $536

Cash price vs list price

Median list price (chargemaster)$521
Median cash price$345
Cash as a share of list, median hospital70%

At the typical hospital, asking for the cash price cuts the list price by about 30%. 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

395 hospitals filed a usable inpatient cash price for this code. The median is $351 and the average of the middle 60% is $351; most fall between $214 and $520.

Cash price percentiles, inpatient, across 395 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
$148$232$351$499$608

The most expensive tenth of hospitals charges at least 4.1× what the cheapest tenth charges ($148 vs $608).

Of the 432 hospitals that filed this code inpatient, 395 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 35 a list price only.

How complete is this

642 of the 3,956 hospitals with a price file in our corpus (16%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 701 hospitals that filed this code at all gave us
Usable cash price — counted642
Cash price carrying a plausibility flag — shown on the compare tool, excluded here14
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 — excluded45
Hospitals that filed this code701

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 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 IP/Obs Consltj New/Est Pt High Mdm 80 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, “Hospital specialist consultation, high-complexity visit (CPT 99255) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-99255-hospital-specialist-consultation-high-complexity-visit