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Outpatient Specialist Consultation Visit

North Carolina 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?

$112

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $107 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$112$79.43 to $141
FacilityA hospital or hospital-owned outpatient department$107$75.86 to $151

How much rates vary

Facilitymedian $107 · 10th to 90th $65 to $191Professionalmedian $112 · 10th to 90th $58 to $182
$10$20$50$100$200facility $107professional $112

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
$66.07
Median
$128.82
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$89.13
Typical High
$177.83
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$93.33
Typical High
$154.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$134.90
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$97.72
Typical High
$165.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$109.65
Typical High
$162.18
Medcost
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$181.97
Medcost
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$100.00
Typical High
$223.87
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$91.20
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$102.33
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$85.11
Typical High
$138.04
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54

Where North Carolina 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.

North Carolina· 2nd of 51

$112

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.