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Specialist Consultation For A Hospitalized Patient

Washington, DC rates for HCPCS 99253

This covers an initial evaluation of a hospitalized patient by a specialist at the request of another treating doctor, seeking advice or a second opinion on the patient's care. It involves a detailed review of the patient's history and a physical exam, along with medical decision-making of low complexity. The requesting doctor remains involved in the patient's care alongside the consulting specialist.

Rates data updated July 2026.

How much does Specialist Consultation For A Hospitalized Patient cost?

$95.50

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $95.50 for this service. Most negotiated rates run $83.18 to $112.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $95 · 10th to 90th $83 to $380Professionalmedian $95 · 10th to 90th $78 to $112
$100$200facility $95professional $95

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
$83.18
Median
$95.50
Typical High
$380.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$95.50
Typical High
$112.20
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$134.90
Typical High
$223.87
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$218.78
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$138.04
Typical High
$239.88

Where Washington, DC sits

The same service costs 2.2 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.

Washington, DC· 51st of 51

$95.50

SD $209DC $95.50

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.