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Outpatient Specialist Consultation Visit

Connecticut 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?

$81.28

Typical negotiated rate. In Connecticut, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $81.28 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 5 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$81.28$60.26 to $112
FacilityA hospital or hospital-owned outpatient department$81.28$63.10 to $95.50

How much rates vary

Facilitymedian $81 · 10th to 90th $60 to $120Professionalmedian $81 · 10th to 90th $47 to $138
$5$10$20$50$100$200facility $81professional $81

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
$60.26
Median
$81.28
Typical High
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$79.43
Typical High
$138.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$79.43
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$100.00
Typical High
$158.49
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$60.26
Typical High
$79.43
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$162.18

Where Connecticut 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.

Connecticut· 28th of 51

$81.28

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.