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Specialist Consultation For A Hospitalized Patient

Georgia 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?

$135

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $135 for this service. The price depends on where it is billed: about $135 from a physician practice, and about $115 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$135$107 to $186
FacilityA hospital or hospital-owned outpatient department$115$100 to $135

How much rates vary

Facilitymedian $115 · 10th to 90th $93 to $145Professionalmedian $135 · 10th to 90th $87 to $282
$100$200facility $115professional $135

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
$93.33
Median
$114.82
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$134.90
Typical High
$288.40
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$186.21
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$208.93
CareSource
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$173.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$147.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$151.36
Typical High
$229.09
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$134.90
Typical High
$263.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$100.00
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$138.04
Typical High
$275.42

Where Georgia 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.

Georgia· 18th of 51

$135

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.