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Specialist Office Consultation

Virginia 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?

$105

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $105 for this service. The price depends on where it is billed: about $105 from a physician practice, and about $126 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$105$83.18 to $129
FacilityA hospital or hospital-owned outpatient department$126$97.72 to $158

How much rates vary

Facilitymedian $126 · 10th to 90th $85 to $200Professionalmedian $105 · 10th to 90th $68 to $162
$0.1$1.0$10.0$100.0$1.0Kfacility $126professional $105

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
$74.13
Median
$97.72
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$147.91
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$87.10
Typical High
$295.12
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$53.70
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$128.82
Typical High
$204.17
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$213.80
Medcost
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$147.91
Typical High
$181.97
Medcost
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$134.90
Typical High
$208.93
Medcost
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$275.42
Sentara
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$114.82
Typical High
$177.83
Sentara
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$120.23
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$123.03
Typical High
$218.78

Where Virginia 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.

Virginia $105 · 39th 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.