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Specialist Consultation For A Hospitalized Patient

Missouri 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 Missouri, 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 $129 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$129$100 to $166
FacilityA hospital or hospital-owned outpatient department$129$97.72 to $170

How much rates vary

Facilitymedian $129 · 10th to 90th $83 to $200Professionalmedian $129 · 10th to 90th $85 to $269
$50$100$200$500facility $129professional $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
$83.18
Median
$112.20
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$128.82
Typical High
$346.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$117.49
Typical High
$194.98
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$107.15
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$138.04
Typical High
$229.09
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$162.18
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$134.90
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$123.03
Typical High
$208.93

Where Missouri 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.

Missouri· 27th 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.