Specialist consultation (standard)

A specialist's opinion visit, requested by another doctor, about 40 minutes.
Code 99243 · Office visits · statewide summary · negotiated in-network prices
Payers shown: CareSource
Prices shown: in-person office visits only
Doctor’s fee or facility fee? These are facility fees: what the insurer pays the hospital or surgery center itself. The doctors who treat you bill separately, on top of it. (About 8% of these prices are doctors' fees instead, which can show up as unusually low prices.) Where a state has both, the table and each state’s popup show the doctor’s fee and the facility fee side by side; their sum is a rough total for the visit, before anything else done during it.
Who is counted: CareSource lists clinicians individually: 96% of the 201,059 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs.
Not on this map: CareSource labels almost every price in its files as a facility ("institutional") price, office visits included. The amounts match what a doctor's visit normally costs, so read the doctor's-fee / facility-fee label on these pages with caution. CareSource publishes no prices for hospital stays in these files. Its files are for its Marketplace (individual) plans; plans for CareSource's own employees are published by UnitedHealthcare and are not included. Hospital stays: CareSource's files have no prices for whole hospital stays (the kind billed as one amount per stay), so there are no hospital-stay maps for it. It may pay hospitals by the day or as a share of their charges, which these maps cannot show.
StateProvidersOrganisationsZip codes Lowest25th pctMedian75th pctHighestDoctor’s feeFacility fee
This is a statewide summary. Prices vary far more between towns and between practices than these medians suggest; zip-code and provider-level detail is not published here; this specific data can be requested here.