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Outpatient Specialist Consultation Visit

New Jersey 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 New Jersey, July 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $83.18 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 6 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$83.18$58.88 to $110
FacilityA hospital or hospital-owned outpatient department$70.79$52.48 to $85.11

How much rates vary

Facilitymedian $71 · 10th to 90th $47 to $100Professionalmedian $83 · 10th to 90th $46 to $141
$5$10$20$50$100$200facility $71professional $83

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
$46.77
Median
$67.61
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$74.13
Typical High
$138.04
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$72.44
Typical High
$107.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$93.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$100.00
Typical High
$158.49
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$54.95
Typical High
$128.82
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$102.33
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$141.25
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$79.43
Typical High
$151.36

Where New Jersey 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.

New Jersey· 26th 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.