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Specialist Consultation For A Hospitalized Patient

Oregon 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?

$162

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $162 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $195 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$158$115 to $219
FacilityA hospital or hospital-owned outpatient department$195$162 to $219

How much rates vary

Facilitymedian $195 · 10th to 90th $123 to $251Professionalmedian $158 · 10th to 90th $93 to $380
$10$20$50$100$200$500facility $195professional $158

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
$208.93
Median
$234.42
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$151.36
Typical High
$389.05
Cigna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$218.78
Typical High
$316.23
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$208.93
Typical High
$251.19
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$190.55
Typical High
$295.12
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$199.53
Typical High
$316.23
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$194.98
Typical High
$218.78
Providence
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$162.18
Typical High
$269.15
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$218.78
Typical High
$288.40
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$323.59
Typical High
$416.87
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$309.03

Where Oregon 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.

Oregon· 5th of 51

$162

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.