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Outpatient Specialist Consultation Visit

Utah 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?

$91.20

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $91.20 for this service. The price depends on where it is billed: about $91.20 from a physician practice, and about $100 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$91.20$58.88 to $123
FacilityA hospital or hospital-owned outpatient department$100$91.20 to $115

How much rates vary

Facilitymedian $100 · 10th to 90th $71 to $135Professionalmedian $91 · 10th to 90th $43 to $191
$5$10$20$50$100$200facility $100professional $91

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$91.20
Typical High
$199.53
Cigna
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$93.33
Typical High
$147.91
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$131.83
Select Health
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Select Health
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$87.10
Typical High
$407.38
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$91.20
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$87.10
Typical High
$141.25

Where Utah 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.

Utah· 14th of 51

$91.20

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.