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Outpatient Specialist Consultation Visit

Colorado rates for HCPCS 99242

In this type of visit, a doctor requests the opinion or advice of another physician or qualified health professional about a specific problem with a patient's care. The consulting clinician evaluates the patient and sends a written report back to the requesting doctor. This particular level involves a relatively limited amount of history-taking, examination, and decision-making compared to higher levels of the same type of visit.

Rates data updated July 2026.

How much does Outpatient Specialist Consultation Visit cost?

$72.44

Typical negotiated rate. In Colorado, July 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $70.79 from a physician practice, and about $93.33 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 7 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$70.79$52.48 to $105
FacilityA hospital or hospital-owned outpatient department$93.33$69.18 to $126

How much rates vary

Facilitymedian $93 · 10th to 90th $48 to $158Professionalmedian $71 · 10th to 90th $8 to $135
$5$10$20$50$100$200facility $93professional $71

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
$4.57
Median
$45.71
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$7.41
Median
$67.61
Typical High
$131.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$72.44
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$100.00
Typical High
$151.36
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$97.72
Typical High
$162.18
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$107.15
Typical High
$204.17
Select Health
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$74.13
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$151.36
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$162.18

Where Colorado sits

The same service costs 1.7 times more in Minnesota than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Colorado· 41st of 51

$72.44

MN $115WV $66.07

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.