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Hospital Consultation, Lower Complexity

Virginia rates for HCPCS 99252

A specialist's opinion on a hospital patient, requested by the doctor already caring for them. The consultant takes a history, examines the patient, reviews the records, and writes back with advice. This is one of the shorter consultations of its kind, for a problem that is fairly limited in complexity.

Rates data updated July 2026.

How much does Hospital Consultation, Lower Complexity cost?

$79.43

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $79.43 for this service. The price depends on where it is billed: about $79.43 from a physician practice, and about $83.18 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$79.43$60.26 to $115
FacilityA hospital or hospital-owned outpatient department$83.18$67.61 to $117

How much rates vary

Facilitymedian $83 · 10th to 90th $59 to $186Professionalmedian $79 · 10th to 90th $52 to $141
$10$100$1K$10Kfacility $83professional $79

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$67.61
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$74.13
Typical High
$138.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.02
Typical High
$107.15
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$58.88
Typical High
$95.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$95.50
Typical High
$169.82
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$89.13
Typical High
$245.47
Medcost
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$89.13
Typical High
$151.36
Medcost
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$165.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$100.00
Sentara
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$95.50
Typical High
$4,073.80
Sentara
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$95.50
Typical High
$4,073.80
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$95.50
Typical High
$158.49

Where Virginia sits

The same service costs 2.3 times more in South Dakota than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Virginia· 46th of 51

$79.43

SD $158DC $67.61

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.