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Specialist Consultation For A Hospitalized Patient

Maine 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?

$129

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $129 for this service. The price depends on where it is billed: about $129 from a physician practice, and about $316 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$129$110 to $155
FacilityA hospital or hospital-owned outpatient department$316$316 to $1,259

How much rates vary

Facilitymedian $316 · 10th to 90th $214 to $1,259Professionalmedian $129 · 10th to 90th $93 to $191
$10$20$50$100$200$500$1Kfacility $316professional $129

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
$213.80
Median
$316.23
Typical High
$1,258.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$123.03
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$144.54
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$223.87
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$147.91
Typical High
$257.04
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$1,258.93
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$123.03
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$158.49
Typical High
$245.47

Where Maine 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.

Maine· 28th of 51

$129

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.