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Specialist Office Consultation

Washington, DC 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?

$100

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $100 for this service. Most negotiated rates run $83.18 to $123.

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

Facilitymedian $437 · 10th to 90th $129 to $437Professionalmedian $100 · 10th to 90th $68 to $148
$10.0$20.0$50.0$100.0$200.0$500.0facility $437professional $100

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
$128.82
Median
$436.52
Typical High
$436.52
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$97.72
Typical High
$141.25
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$53.70
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$123.03
Typical High
$199.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$245.47
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$97.72
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$131.83
Typical High
$234.42

Where Washington, DC 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.

Washington, DC $100 · 48th 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.