go back

Specialist Office Consultation

South Dakota 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 South Dakota, 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 $132 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$102$83.18 to $126
FacilityA hospital or hospital-owned outpatient department$132$102 to $182

How much rates vary

Facilitymedian $132 · 10th to 90th $83 to $234Professionalmedian $102 · 10th to 90th $72 to $170
$10.0$20.0$50.0$100.0$200.0$500.0facility $132professional $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
$93.33
Median
$95.50
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$97.72
Typical High
$128.82
Avera
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$104.71
Typical High
$208.93
Medica
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$134.90
Typical High
$234.42
Medica
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$194.98
Typical High
$741.31
Midlands
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$223.87
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$147.91
Typical High
$245.47
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$123.03
Typical High
$158.49

Where South Dakota 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.

South Dakota $102 · 45th 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.