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Outpatient Specialist Consultation Visit

South 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?

$77.62

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $77.62 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$77.62$58.88 to $110
FacilityA hospital or hospital-owned outpatient department$97.72$75.86 to $132

How much rates vary

Facilitymedian $98 · 10th to 90th $62 to $162Professionalmedian $78 · 10th to 90th $46 to $145
$5$10$20$50$100$200facility $98professional $78

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
Professional
Modifier
Global
Typical Low
$45.71
Median
$75.86
Typical High
$144.54
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$154.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$102.33
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
$91.20
Typical High
$138.04
Medcost
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$138.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$97.72
Typical High
$162.18
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$54.95
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$81.28
Typical High
$120.23

Where South 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.

South Carolina· 34th of 51

$77.62

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.