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Outpatient Specialist Consultation Visit

Delaware 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 physician fee. In Delaware, July 2026.

Insurers have agreed to pay about $72.44 for this service. Most negotiated rates run $53.70 to $105.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $4 · 10th to 90th $3 to $9Professionalmedian $72 · 10th to 90th $41 to $129
$5$10$20$50$100$200facility $4professional $72

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
$3.39
Median
$4.47
Typical High
$8.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$70.79
Typical High
$128.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$89.13
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$83.18
Typical High
$125.89

Where Delaware 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.

Delaware· 44th 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.