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Specialist Office Consultation

Oregon 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?

$129

Typical negotiated rate. In Oregon, July 2026.

Insurers have agreed to pay about $129 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $170 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$126$97.72 to $200
FacilityA hospital or hospital-owned outpatient department$170$123 to $224

How much rates vary

Facilitymedian $170 · 10th to 90th $93 to $240Professionalmedian $126 · 10th to 90th $76 to $282
$1.0$10.0$100.0$1.0K$10.0Kfacility $170professional $126

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
$204.17
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$114.82
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$169.82
Typical High
$275.42
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$208.93
Typical High
$269.15
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$141.25
Typical High
$239.88
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$204.17
Typical High
$275.42
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$223.87
Typical High
$234.42
Providence
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$141.25
Typical High
$239.88
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$208.93
Typical High
$281.84
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$380.19
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$100.00
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$186.21
Typical High
$288.40

Where Oregon 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.

Oregon $129 · 3rd 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.