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Outpatient Specialist Consultation Visit

Massachusetts 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?

$95.50

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $95.50 for this service. The price depends on where it is billed: about $95.50 from a physician practice, and about $89.13 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$95.50$66.07 to $129
FacilityA hospital or hospital-owned outpatient department$89.13$67.61 to $126

How much rates vary

Facilitymedian $89 · 10th to 90th $40 to $148Professionalmedian $95 · 10th to 90th $51 to $178
$10$20$50$100$200facility $89professional $95

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
$67.61
Median
$112.20
Typical High
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$89.13
Typical High
$154.88
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$416.87
Typical High
$416.87
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$102.33
Typical High
$309.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$100.00
Typical High
$165.96
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$52.48
Typical High
$91.20
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$79.43
Typical High
$120.23
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$112.20
Typical High
$181.97
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$416.87
Typical High
$416.87
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$102.33
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$154.88
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$104.71
Typical High
$199.53

Where Massachusetts 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.

Massachusetts· 8th of 51

$95.50

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.