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Specialist Consultation For A Hospitalized Patient

Indiana 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?

$112

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $115 from a physician practice, and about $93.33 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 6 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$115$89.13 to $145
FacilityA hospital or hospital-owned outpatient department$93.33$85.11 to $117

How much rates vary

Facilitymedian $93 · 10th to 90th $72 to $132Professionalmedian $115 · 10th to 90th $76 to $229
$100$200facility $93professional $115

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
$67.61
Median
$89.13
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$234.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$104.71
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$223.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$117.49
Typical High
$181.97
CareSource
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$120.23
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$123.03
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$117.49
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$117.49
Typical High
$181.97
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$128.82
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$117.49
Typical High
$186.21

Where Indiana 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.

Indiana· 44th of 51

$112

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.