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Outpatient Specialist Consultation Visit

Georgia 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?

$87.10

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $87.10 for this service. The price depends on where it is billed: about $87.10 from a physician practice, and about $87.10 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 8 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$87.10$63.10 to $115
FacilityA hospital or hospital-owned outpatient department$87.10$72.44 to $115

How much rates vary

Facilitymedian $87 · 10th to 90th $56 to $135Professionalmedian $87 · 10th to 90th $49 to $145
$10$20$50$100$200facility $87professional $87

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
$56.23
Median
$87.10
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$85.11
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$61.66
Typical High
$154.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$83.18
Typical High
$151.36
CareSource
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$66.07
Typical High
$75.86
CareSource
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$109.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$158.49
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$95.50
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$93.33
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$91.20
Typical High
$147.91

Where Georgia 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.

Georgia· 18th of 51

$87.10

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.