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Specialist Office Consultation

Colorado 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?

$102

Typical negotiated rate. In Colorado, July 2026.

Insurers have agreed to pay about $102 for this service. The price depends on where it is billed: about $102 from a physician practice, and about $135 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$102$77.62 to $126
FacilityA hospital or hospital-owned outpatient department$135$107 to $170

How much rates vary

Facilitymedian $135 · 10th to 90th $87 to $209Professionalmedian $102 · 10th to 90th $11 to $151
$1.0$10.0$100.0facility $135professional $102

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
$8.32
Median
$75.86
Typical High
$109.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$11.22
Median
$97.72
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$97.72
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$112.20
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$141.25
Typical High
$213.80
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$138.04
Typical High
$213.80
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$158.49
Typical High
$331.13
Select Health
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$114.82
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$165.96
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$138.04
Typical High
$234.42

Where Colorado sits

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.

Colorado $102 · 46th of 51
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.