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Outpatient Specialist Consultation Visit

North Dakota 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?

$83.18

Typical negotiated rate. In North Dakota, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $70.79 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 4 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$85.11$66.07 to $120
FacilityA hospital or hospital-owned outpatient department$70.79$64.57 to $89.13

How much rates vary

Facilitymedian $71 · 10th to 90th $51 to $126Professionalmedian $85 · 10th to 90th $52 to $145
$50$100$200facility $71professional $85

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
$51.29
Median
$69.18
Typical High
$89.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$83.18
Typical High
$141.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$87.10
Typical High
$120.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$93.33
Typical High
$169.82
Medica
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$151.36
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$104.71
Typical High
$186.21

Where North Dakota 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 Dakota· 22nd of 51

$83.18

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.