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Specialist Consultation For A Hospitalized Patient

Utah 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?

$132

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $132 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $115 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$132$105 to $170
FacilityA hospital or hospital-owned outpatient department$115$115 to $135

How much rates vary

Facilitymedian $115 · 10th to 90th $115 to $135Professionalmedian $132 · 10th to 90th $87 to $269
$20$50$100$200facility $115professional $132

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
$114.82
Median
$114.82
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$131.83
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$162.18
Typical High
$269.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$181.97
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$181.97
Select Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$141.25
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$138.04
Typical High
$199.53

Where Utah 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.

Utah· 23rd of 51

$132

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.