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Specialist Office Consultation

Kentucky 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 Kentucky, 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 $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 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$81.28 to $126
FacilityA hospital or hospital-owned outpatient department$87.10$74.13 to $107

How much rates vary

Facilitymedian $87 · 10th to 90th $65 to $123Professionalmedian $102 · 10th to 90th $68 to $170
$10.0$20.0$50.0$100.0$200.0$500.0facility $87professional $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
$64.57
Median
$83.18
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$104.71
Typical High
$169.82
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$109.65
Typical High
$147.91
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$72.44
Typical High
$117.49
CareSource
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$91.20
Typical High
$123.03
CareSource
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$123.03
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$131.83
Typical High
$537.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$91.20
Typical High
$123.03
United
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$114.82
Typical High
$181.97

Where Kentucky 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.

Kentucky $102 · 44th 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.