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Specialist Consultation For A Hospitalized Patient

Virginia 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?

$112

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $107 from a physician practice, and about $123 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$107$91.20 to $138
FacilityA hospital or hospital-owned outpatient department$123$95.50 to $166

How much rates vary

Facilitymedian $123 · 10th to 90th $83 to $269Professionalmedian $107 · 10th to 90th $81 to $182
$10$100$1K$10Kfacility $123professional $107

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
$81.28
Median
$95.50
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$169.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.03
Typical High
$275.42
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$138.04
Typical High
$263.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$123.03
Typical High
$380.19
Medcost
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$134.90
Typical High
$204.17
Medcost
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$151.36
Typical High
$223.87
Medcost
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$109.65
Sentara
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$144.54
Typical High
$4,073.80
Sentara
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$141.25
Typical High
$4,073.80
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$138.04
Typical High
$251.19

Where Virginia 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.

Virginia· 45th of 51

$112

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.