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Specialist Office Consultation

Iowa 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?

$115

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $115 from a physician practice, and about $145 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$115$91.20 to $166
FacilityA hospital or hospital-owned outpatient department$145$105 to $200

How much rates vary

Facilitymedian $145 · 10th to 90th $83 to $229Professionalmedian $115 · 10th to 90th $74 to $398
$10.0$20.0$50.0$100.0$200.0$500.0facility $145professional $115

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
$125.89
Median
$181.97
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$109.65
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$123.03
Typical High
$234.42
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$165.96
Typical High
$426.58
Medica
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$128.82
Typical High
$229.09
Medica
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$181.97
Typical High
$741.31
Midlands
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$380.19
Midlands
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$213.80
Typical High
$363.08
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$218.78
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$120.23
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$158.49
Typical High
$275.42
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$123.03
Typical High
$154.88

Where Iowa 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.

Iowa $115 · 15th 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.