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Specialist Consultation For A Hospitalized Patient

South Dakota 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?

$209

Typical physician fee. In South Dakota, July 2026.

Insurers have agreed to pay about $209 for this service. Most negotiated rates run $126 to $257.

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.

How much rates vary

Facilitymedian $155 · 10th to 90th $98 to $209Professionalmedian $209 · 10th to 90th $93 to $295
$100$200facility $155professional $209

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$97.72
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$208.93
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$239.88
Typical High
$275.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$158.49
Typical High
$213.80
Medica
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$707.95
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$173.78
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$190.55
Typical High
$239.88
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$141.25

Where South Dakota 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.

South Dakota· 1st of 51

$209

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.