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Specialist Office Consultation

North Carolina 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?

$141

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $141 for this service. The price depends on where it is billed: about $141 from a physician practice, and about $138 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$141$107 to $200
FacilityA hospital or hospital-owned outpatient department$138$107 to $178

How much rates vary

Facilitymedian $138 · 10th to 90th $93 to $240Professionalmedian $141 · 10th to 90th $83 to $275
$5.0$10.0$20.0$50.0$100.0$200.0$500.0facility $138professional $141

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
$93.33
Median
$134.90
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$114.82
Typical High
$302.00
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$151.36
Typical High
$208.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$190.55
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$134.90
Typical High
$234.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$147.91
Typical High
$218.78
Medcost
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$138.04
Typical High
$213.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$109.65
Typical High
$309.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$125.89
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$117.49
Typical High
$204.17
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$588.84
Typical High
$588.84
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31

Where North Carolina 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.

North Carolina $141 · 2nd 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.