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Procedure price report · Consultation, evaluation, and preventative care

Specialist clinic consultation, low-complexity visit

CPT 99243the billing code this page is about

An office or outpatient consultation requested by another provider, at the level involving a problem of low complexity and a moderate amount of physician time and decision-making.

Hospitals typically charge $175 cash for this outpatient procedure — the median across 988 hospitals that filed a usable cash price; the average of the middle 60% is $179. Most fall between $91 and $299 (20th–80th percentile).

Hospitals
988
States
49
Filings dated
Aug 2022 – Sep 2026
Computed
September 25, 2026
Prices checked
through September 24, 2026

Median: half of hospitals filed less, half more — and it is a price some hospital actually filed. Average of the middle 60%: the mean of the prices between the 20th and 80th percentiles. We never publish the plain average, the lowest or the highest price: the extremes in hospital price files are chargemaster artefacts, not prices anyone pays.

What hospitals charge, from cheapest to most expensive

Cash price percentiles, outpatient, across 988 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$66$104$175$264$405

The most expensive tenth of hospitals charges at least 6.1× what the cheapest tenth charges ($66 vs $405).

How the prices are spread

$47 – $59: 29 hospitals$47$59 – $75: 43 hospitals$75 – $94: 87 hospitals$75$94 – $118: 87 hospitals$118 – $149: 123 hospitals$118$149 – $188: 113 hospitals$188 – $236: 144 hospitals$188$236 – $297: 111 hospitals$297 – $374: 82 hospitals$297$374 – $471: 77 hospitals$374median $175price bands are equal on a log scale
Hospitals per price band (896 of 988 — the bands cover the 5th to 95th percentile)
FromToHospitals
$47$5929
$59$7543
$75$9487
$94$11887
$118$149123
$149$188113
$188$236144
$236$297111
$297$37482
$374$47177

By state

The median cash price in each state, against the national median of $175.

Alaska: median $413 across 11 hospitalsAK$413Maine: median $104 across 20 hospitalsME$104Vermont: median $222 across 11 hospitalsVT$222New Hampshire: 9 hospitals filed a usable price — fewer than 10, so no figureNHWashington: median $208 across 28 hospitalsWA$208Idaho: 5 hospitals filed a usable price — fewer than 10, so no figureIDMontana: median $206 across 16 hospitalsMT$206North Dakota: 8 hospitals filed a usable price — fewer than 10, so no figureNDMinnesota: median $257 across 50 hospitalsMN$257Illinois: median $157 across 38 hospitalsIL$157Wisconsin: median $200 across 55 hospitalsWI$200Michigan: median $136 across 41 hospitalsMI$136New York: median $318 across 60 hospitalsNY$318Massachusetts: median $191 across 14 hospitalsMA$191Oregon: median $205 across 12 hospitalsOR$205Nevada: 6 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 9 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 7 hospitals filed a usable price — fewer than 10, so no figureSDIowa: median $219 across 47 hospitalsIA$219Indiana: median $100 across 29 hospitalsIN$100Ohio: median $109 across 26 hospitalsOH$109Pennsylvania: median $167 across 43 hospitalsPA$167New Jersey: median $250 across 12 hospitalsNJ$250Connecticut: 9 hospitals filed a usable price — fewer than 10, so no figureCTRhode Island: 1 hospital filed a usable price — fewer than 10, so no figureRICalifornia: median $165 across 43 hospitalsCA$165Utah: 2 hospitals filed a usable price — fewer than 10, so no figureUTColorado: median $161 across 17 hospitalsCO$161Nebraska: median $221 across 22 hospitalsNE$221Missouri: median $131 across 36 hospitalsMO$131Kentucky: median $88 across 20 hospitalsKY$88West Virginia: median $99 across 20 hospitalsWV$99Virginia: 6 hospitals filed a usable price — fewer than 10, so no figureVAMaryland: 4 hospitals filed a usable price — fewer than 10, so no figureMDDelaware: no hospital in the corpus filed a usable priceDEArizona: median $114 across 10 hospitalsAZ$114New Mexico: 5 hospitals filed a usable price — fewer than 10, so no figureNMKansas: median $176 across 30 hospitalsKS$176Arkansas: median $155 across 12 hospitalsAR$155Tennessee: median $91 across 10 hospitalsTN$91North Carolina: median $148 across 11 hospitalsNC$148South Carolina: 9 hospitals filed a usable price — fewer than 10, so no figureSCOklahoma: median $139 across 21 hospitalsOK$139Louisiana: 8 hospitals filed a usable price — fewer than 10, so no figureLAMississippi: median $127 across 22 hospitalsMS$127Alabama: median $139 across 14 hospitalsAL$139Georgia: median $225 across 29 hospitalsGA$225Hawaii: median $124 across 11 hospitalsHI$124Texas: median $120 across 35 hospitalsTX$120Florida: median $280 across 24 hospitalsFL$280
Cash price by state, most expensive first. National median $175. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
Alaska AK11$413+137%$264 – $433
New York NY60$318+82%$103 – $437
Florida FL24$280+60%$94 – $334
Minnesota MN50$257+47%$142 – $389
New Jersey NJ12$250+43%$250 – $868
Georgia GA29$225+29%$107 – $414
Vermont VT11$222+27%$143 – $288
Nebraska NE22$221+26%$179 – $258
Iowa IA47$219+25%$144 – $256
Washington WA28$208+19%$158 – $298
Montana MT16$206+18%$65 – $322
Oregon OR12$205+18%$126 – $224
Wisconsin WI55$200+15%$143 – $332
Massachusetts MA14$191+9%$98 – $346
Kansas KS30$176+1%$118 – $208
Pennsylvania PA43$167−5%$68 – $255
California CA43$165−6%$62 – $320
Colorado CO17$161−8%$70 – $292
Illinois IL38$157−10%$88 – $379
Arkansas AR12$155−12%$66 – $223
North Carolina NC11$148−16%$74 – $188
Alabama AL14$139−20%$113 – $355
Oklahoma OK21$139−21%$108 – $154
Michigan MI41$136−22%$111 – $176
Missouri MO36$131−25%$91 – $210
Mississippi MS22$127−27%$87 – $152
Hawaii HI11$124−29%$75 – $150
Texas TX35$120−31%$89 – $210
Arizona AZ10$114−35%$71 – $171
Ohio OH26$109−38%$72 – $179
Maine ME20$104−41%$37 – $269
Indiana IN29$100−43%$65 – $265
West Virginia WV20$99−44%$75 – $196
Tennessee TN10$91−48%$86 – $158
Kentucky KY20$88−50%$75 – $157
Connecticut CT9not enough hospitals filed a usable price
New Hampshire NH9not enough hospitals filed a usable price
South Carolina SC9not enough hospitals filed a usable price
Wyoming WY9not enough hospitals filed a usable price
Louisiana LA8not enough hospitals filed a usable price
North Dakota ND8not enough hospitals filed a usable price
South Dakota SD7not enough hospitals filed a usable price
Nevada NV6not enough hospitals filed a usable price
Virginia VA6not enough hospitals filed a usable price
Idaho ID5not enough hospitals filed a usable price
New Mexico NM5not enough hospitals filed a usable price
Maryland MD4not enough hospitals filed a usable price
Utah UT2not enough hospitals filed a usable price
Rhode Island RI1not enough hospitals filed a usable price

Hospitals like yours

The same distribution cut by the kind of hospital. Hospital type and ownership come from CMS; a hospital counts as part of a system when its price file is shared with at least one other hospital under the same brand. The national median is $175.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care564$160$89 – $291
Children’s28$236$124 – $400
Critical access394$192$99 – $298
Ownership
For-profit56$132$75 – $278
Government271$171$106 – $280
Non-profit659$184$91 – $320
System affiliation
Part of a system706$169$89 – $291
Independent282$181$107 – $310

Cash price vs list price

Median list price (chargemaster)$267
Median cash price$175
Cash as a share of list, median hospital70%

At the typical hospital, asking for the cash price cuts the list price by about 30%. The share is the median of each hospital’s own cash ÷ list ratio, over hospitals that filed both — not the ratio of the two medians above.

The same procedure, inpatient

568 hospitals filed a usable inpatient cash price for this code. The median is $173 and the average of the middle 60% is $180; most fall between $90 and $293.

Cash price percentiles, inpatient, across 568 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$75$104$173$260$381

The most expensive tenth of hospitals charges at least 5.1× what the cheapest tenth charges ($75 vs $381).

Of the 615 hospitals that filed this code inpatient, 568 gave a usable cash price; 8 carried a plausibility flag, 0 filed a number their own filing marks as not a price, 0 gave an estimate, and 39 a list price only.

How complete is this

988 of the 3,956 hospitals with a price file in our corpus (25%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 1,084 hospitals that filed this code at all gave us
Usable cash price — counted988
Cash price carrying a plausibility flag — shown on the compare tool, excluded here28
A number the filing itself marks as not a price (a placeholder, a ratio) — excluded2
An estimate rather than a filed cash price — excluded0
A list price only, no cash figure — excluded66
Hospitals that filed this code1,084

Sections not shown for this setting

  • Against Medicare: Medicare has no separately payable national outpatient (OPPS) rate for this code, so there is nothing honest to compare against.
  • Since our last snapshot: there is no earlier snapshot at least 90 days older than this one yet.

We last checked these hospitals’ price files for changes between July 20, 2026 and September 24, 2026; the figures were computed September 25, 2026 from filings loaded through September 24, 2026. The percentiles and averages use only the “counted” row.

Related procedures

Part of the Consultation, evaluation, and preventative care family.

Hospitals file this code under descriptions such as Office/OP Consltj New/Est Pt Low Mdm 30 Minutes.

Method

Source
The machine-readable price files every U.S. hospital is required by CMS to publish, parsed per hospital. Nothing is surveyed, sampled or modelled.
What counts
One cash (self-pay) price per hospital for this code and setting. A hospital’s own filing can rule its number out — a placeholder, a “not applicable” note, a list price standing in for cash — and our plausibility checks can flag a price far below what every other hospital files. Both kinds are disclosed above and excluded from the statistics; on the compare tool a flagged price is still shown.
Statistics
Percentiles are discrete: each is a price some hospital filed. The average is the mean of the prices between the 20th and 80th percentiles. We never publish the plain mean, the minimum or the maximum. A state needs 10 hospitals and a segment 20 to show a figure; otherwise the row shows its count and no number. Medicare is the national unadjusted OPPS rate where one exists.
Names
Procedure names on these pages are our own plain-language titles, not the AMA’s copyrighted CPT descriptors. The code is the identity.

The full rules — sources, statistics, thresholds, limitations — are on the methodology page.

Download this page’s figures: JSON · CSV. Aggregates only — the per-hospital prices are on the compare tool.

Cite: HospitalRates.com, “Specialist clinic consultation, low-complexity visit (CPT 99243) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-99243-specialist-clinic-consultation-low-complexity-visit