go back

Specialist Office Consultation

Georgia 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?

$112

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $110 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 8 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$112$93.33 to $138
FacilityA hospital or hospital-owned outpatient department$110$100 to $135

How much rates vary

Facilitymedian $110 · 10th to 90th $78 to $174Professionalmedian $112 · 10th to 90th $76 to $204
$5.0$10.0$20.0$50.0$100.0$200.0$500.0facility $110professional $112

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
$77.62
Median
$109.65
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$109.65
Typical High
$199.53
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$112.20
Typical High
$489.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$117.49
Typical High
$208.93
CareSource
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$107.15
Typical High
$120.23
CareSource
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$134.90
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$134.90
Typical High
$213.80
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$234.42
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$741.31
Typical High
$741.31
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$120.23
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$223.87

Where Georgia 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.

Georgia $112 · 18th 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.