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Outpatient Specialist Consultation Visit

Nebraska 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?

$72.44

Typical negotiated rate. In Nebraska, July 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $72.44 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 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$72.44$57.54 to $105
FacilityA hospital or hospital-owned outpatient department$89.13$66.07 to $126

How much rates vary

Facilitymedian $89 · 10th to 90th $52 to $155Professionalmedian $72 · 10th to 90th $46 to $141
$5$10$20$50$100$200facility $89professional $72

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
$39.81
Median
$52.48
Typical High
$70.79
Aetna
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$70.79
Typical High
$138.04
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$72.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$93.33
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$93.33
Typical High
$165.96
Medica
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$89.13
Typical High
$154.88
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$151.36
Typical High
$537.03
Midlands
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$181.97
Midlands
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$147.91
Typical High
$181.97
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$64.57
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$0.09
Median
$30.20
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$104.71
Typical High
$186.21

Where Nebraska 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.

Nebraska· 43rd of 51

$72.44

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.