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Specialist Consultation For A Hospitalized Patient

Iowa 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?

$155

Typical physician fee. In Iowa, July 2026.

Insurers have agreed to pay about $155 for this service. Most negotiated rates run $105 to $263.

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.

How much rates vary

Facilitymedian $162 · 10th to 90th $85 to $234Professionalmedian $155 · 10th to 90th $85 to $407
$100$200$500facility $162professional $155

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
$85.11
Median
$144.54
Typical High
$234.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$154.88
Typical High
$407.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$134.90
Typical High
$309.03
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$177.83
Typical High
$380.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$234.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$190.55
Typical High
$707.95
Midlands
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$199.53
Typical High
$309.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$199.53
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$263.03
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$134.90

Where Iowa 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.

Iowa· 7th of 51

$155

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.