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Specialist Consultation For A Hospitalized Patient

Montana 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?

$145

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $135 from a physician practice, and about $170 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$135$105 to $170
FacilityA hospital or hospital-owned outpatient department$170$170 to $191

How much rates vary

Facilitymedian $170 · 10th to 90th $141 to $302Professionalmedian $135 · 10th to 90th $91 to $380
$10$100$1K$10K$100Kfacility $170professional $135

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
Professional
Modifier
Global
Typical Low
$91.20
Median
$131.83
Typical High
$380.19
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$144.54
Typical High
$190.55
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$173.78
Typical High
$190.55
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$173.78
Typical High
$190.55
Providence
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$275.42
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$151.36
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$229.09

Where Montana 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.

Montana· 9th of 51

$145

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.