search again

Specialist Office Consultation

Nationwide rates for HCPCS 99243

This service covers an office visit where a specialist reviews a patient's specific health problem at the request of another treating clinician and provides an opinion or recommendation. It involves a detailed review of the person's history and a focused examination, along with medical decision-making of low complexity. A written report is typically sent back to the requesting clinician.

Rates data updated July 2026.

How much does Specialist Office Consultation cost?

$110

Typical negotiated rate. Nationwide, July 2026.

Insurers have agreed to pay about $110 for this service. The price depends on where it is billed: about $110 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 73 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$110$89.13 to $141
FacilityA hospital or hospital-owned outpatient department$123$93.33 to $162

How much rates vary

Facilitymedian $123 · 10th to 90th $76 to $219Professionalmedian $110 · 10th to 90th $72 to $219
$0.1$1.0$10.0$100.0$1.0K$10.0K$100.0Kfacility $123professional $110

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
$64.57
Median
$100.00
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$107.15
Typical High
$186.21
BCBS
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$89.13
Typical High
$100.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$100.00
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$123.03
Typical High
$154.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$112.20
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$128.82
Typical High
$288.40

What it costs in each state

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

MN $145WV $97.72

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.