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Specialist Consultation For A Hospitalized Patient

Vermont 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?

$135

Typical physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $135 for this service. Most negotiated rates run $120 to $191.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $135 · 10th to 90th $105 to $195
$100$200professional $135

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
Professional
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$194.98
BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$154.88
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$239.88
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.05
Median
$0.05
Typical High
$0.05
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$158.49
Typical High
$245.47

Where Vermont 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.

Vermont· 16th of 51

$135

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.