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Specialist Office Consultation

Indiana 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 negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $100 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $87.10 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 6 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$100$81.28 to $120
FacilityA hospital or hospital-owned outpatient department$87.10$75.86 to $110

How much rates vary

Facilitymedian $87 · 10th to 90th $68 to $141Professionalmedian $100 · 10th to 90th $68 to $145
$5.0$10.0$20.0$50.0$100.0$200.0$500.0facility $87professional $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
$67.61
Median
$85.11
Typical High
$125.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$141.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$162.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$107.15
Typical High
$165.96
CareSource
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$104.71
Typical High
$114.82
CareSource
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$128.82
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$112.20
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$123.03
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$107.15
Typical High
$131.83
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$117.49
Typical High
$186.21

Where Indiana 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.

Indiana $100 · 49th 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.