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Specialist Consultation For A Hospitalized Patient

West 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?

$123

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $12.59 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 4 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$97.72 to $234
FacilityA hospital or hospital-owned outpatient department$12.59$11.22 to $112

How much rates vary

Facilitymedian $13 · 10th to 90th $11 to $132Professionalmedian $132 · 10th to 90th $72 to $302
$20$50$100$200facility $13professional $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
$11.22
Median
$11.22
Typical High
$131.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$131.83
Typical High
$302.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$107.15
Typical High
$125.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Cigna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$218.78
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$109.65
Typical High
$173.78

Where West 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.

West Virginia· 36th of 51

$123

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.