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Outpatient Specialist Consultation Visit

Maine 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?

$93.33

Typical physician fee. In Maine, July 2026.

Insurers have agreed to pay about $93.33 for this service. Most negotiated rates run $67.61 to $117.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $81 · 10th to 90th $63 to $115Professionalmedian $93 · 10th to 90th $56 to $145
$50$100$200facility $81professional $93

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
$63.10
Median
$81.28
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$89.13
Typical High
$138.04
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$67.61
Typical High
$114.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$95.50
Typical High
$165.96
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$107.15
Typical High
$181.97
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$114.82
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$89.13
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$104.71
Typical High
$177.83

Where Maine 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.

Maine· 10th of 51

$93.33

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.