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Outpatient Specialist Consultation Visit

Missouri 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?

$81.28

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $97.72 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$81.28$57.54 to $115
FacilityA hospital or hospital-owned outpatient department$97.72$75.86 to $129

How much rates vary

Facilitymedian $98 · 10th to 90th $62 to $151Professionalmedian $81 · 10th to 90th $47 to $148
$5$10$20$50$100$200facility $98professional $81

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
$81.28
Median
$109.65
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$79.43
Typical High
$147.91
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$61.66
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$66.07
Typical High
$114.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$74.13
Typical High
$109.65
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$91.20
Typical High
$144.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$93.33
Typical High
$169.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$112.20
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$30.20
Median
$81.28
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$134.90

Where Missouri 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.

Missouri· 31st of 51

$81.28

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.