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Outpatient Specialist Consultation Visit

Kentucky 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?

$70.79

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $70.79 for this service. The price depends on where it is billed: about $70.79 from a physician practice, and about $54.95 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$53.70 to $105
FacilityA hospital or hospital-owned outpatient department$54.95$52.48 to $70.79

How much rates vary

Facilitymedian $55 · 10th to 90th $44 to $78Professionalmedian $71 · 10th to 90th $44 to $141
$10$20$50$100$200facility $55professional $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
$41.69
Median
$53.70
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$141.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$69.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$47.86
Typical High
$81.28
CareSource
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$56.23
Typical High
$75.86
CareSource
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$75.86
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$95.50
Typical High
$407.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$67.61
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$83.18
Typical High
$125.89

Where Kentucky 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.

Kentucky· 48th of 51

$70.79

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.