go back

Hospital Consultation, Moderate Complexity

Kentucky rates for HCPCS 99254

This describes a visit where one physician asks another physician, usually a specialist, to evaluate a hospitalized patient and give an opinion or recommendation on a moderately complex medical problem. The consulting physician reviews the case, examines the patient, and documents findings and recommendations back to the physician who requested the opinion.

Rates data updated July 2026.

How much does Hospital Consultation, Moderate Complexity cost?

$145

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $132 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$148$117 to $219
FacilityA hospital or hospital-owned outpatient department$132$115 to $141

How much rates vary

Facilitymedian $132 · 10th to 90th $100 to $191Professionalmedian $148 · 10th to 90th $100 to $389
$10.0$20.0$50.0$100.0$200.0$500.0facility $132professional $148

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
$100.00
Median
$131.83
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$407.38
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$144.54
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$117.49
Typical High
$229.09
CareSource
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$204.17
CareSource
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$158.49
Typical High
$204.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$257.04
Typical High
$660.69
Molina
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$112.20
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$177.83
Typical High
$281.84

Where Kentucky sits

The same service costs 2.0 times more in South Dakota than in Washington, DC. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Kentucky $145 · 47th of 51
SD $263DC $132

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.