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Outpatient Specialist Consultation Visit

Texas 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.

Facilitymedian $93 · 10th–90th $51$1780%5%10th90th$93Professionalmedian $85 · 10th–90th $45$1410%5%10%10th90th$85$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$54.95
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$85.11
Typical High
$141.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$72.44
Typical High
$154.88
BCBS
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$173.78
Typical High
$354.81
BCBS
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$60.26
Typical High
$89.13
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$114.82
Christus
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$93.33
Typical High
$147.91
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$416.87
Typical High
$416.87
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$549.54
Typical High
$549.54
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$95.50
Typical High
$165.96
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$89.13
Typical High
$141.25
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$67.61
Typical High
$81.28
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$95.50
Typical High
$177.83
Providence
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$95.50
Typical High
$165.96
Providence
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$95.50
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$79.43
Typical High
$109.65
United
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$83.18
Typical High
$128.82
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$75.86
Typical High
$81.28