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Specialist Office Consultation

Maine 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?

$120

Typical physician fee. In Maine, July 2026.

Insurers have agreed to pay about $120 for this service. Most negotiated rates run $97.72 to $151.

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.

How much rates vary

Facilitymedian $107 · 10th to 90th $87 to $123Professionalmedian $120 · 10th to 90th $81 to $224
$10.0$100.0$1.0K$10.0Kfacility $107professional $120

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
$87.10
Median
$107.15
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$112.20
Typical High
$158.49
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$102.33
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$134.90
Typical High
$245.47
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$165.96
Typical High
$275.42
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$107.15
Typical High
$125.89
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$114.82
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$151.36
Typical High
$269.15

Where Maine 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.

Maine $120 · 8th 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.