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Specialist Consultation For A Hospitalized Patient

North Carolina 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 North Carolina, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $145 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 8 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$145$112 to $209
FacilityA hospital or hospital-owned outpatient department$145$112 to $191

How much rates vary

Facilitymedian $145 · 10th to 90th $112 to $324Professionalmedian $145 · 10th to 90th $87 to $302
$20$50$100$200facility $145professional $145

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
$112.20
Median
$141.25
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$131.83
Typical High
$309.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$134.90
Typical High
$204.17
BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$194.98
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$144.54
Typical High
$234.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Medcost
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$229.09
Medcost
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$281.84
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$134.90
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$125.89
Typical High
$229.09
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95

Where North Carolina 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.

North Carolina· 8th 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.