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Specialist Consultation For A Hospitalized Patient

Michigan 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?

$123

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $123 from a physician practice, and about $107 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 7 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$123$97.72 to $155
FacilityA hospital or hospital-owned outpatient department$107$81.28 to $107

How much rates vary

Facilitymedian $107 · 10th to 90th $81 to $107Professionalmedian $123 · 10th to 90th $83 to $229
$100$200facility $107professional $123

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
$81.28
Median
$107.15
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$123.03
Typical High
$234.42
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$141.25
Typical High
$190.55
BCBS
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$151.36
Typical High
$162.18
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$128.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$128.82
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$117.49
Typical High
$199.53
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$295.12
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$123.03
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$104.71
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$275.42

Where Michigan 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.

Michigan· 33rd of 51

$123

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.