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Specialist Office Consultation

Utah 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?

$115

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $115 for this service. The price depends on where it is billed: about $115 from a physician practice, and about $115 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 6 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$115$89.13 to $145
FacilityA hospital or hospital-owned outpatient department$115$100 to $123

How much rates vary

Facilitymedian $115 · 10th to 90th $98 to $135Professionalmedian $115 · 10th to 90th $65 to $389
$10.0$20.0$50.0$100.0$200.0$500.0facility $115professional $115

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$114.82
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$112.20
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$131.83
Typical High
$208.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$186.21
Select Health
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Select Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$131.83
Typical High
$512.86
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$138.04
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$123.03
Typical High
$199.53

Where Utah 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.

Utah $115 · 16th 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.