go back

Outpatient Specialist Consultation Visit

Iowa 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?

$85.11

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $105 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$85.11$63.10 to $135
FacilityA hospital or hospital-owned outpatient department$105$75.86 to $132

How much rates vary

Facilitymedian $105 · 10th to 90th $62 to $170Professionalmedian $85 · 10th to 90th $49 to $295
$50$100$200facility $105professional $85

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
$79.43
Median
$123.03
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$83.18
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$87.10
Typical High
$165.96
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$117.49
Typical High
$302.00
Medica
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$91.20
Typical High
$169.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$131.83
Typical High
$537.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$288.40
Midlands
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$288.40
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$83.18
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$85.11
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$186.21
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$79.43
Typical High
$102.33

Where Iowa 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.

Iowa· 20th of 51

$85.11

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.