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Outpatient Specialist Consultation Visit

Virginia 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?

$75.86

Typical negotiated rate. In Virginia, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $87.10 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$74.13$57.54 to $105
FacilityA hospital or hospital-owned outpatient department$87.10$67.61 to $120

How much rates vary

Facilitymedian $87 · 10th to 90th $56 to $148Professionalmedian $74 · 10th to 90th $47 to $135
$5$10$20$50$100$200$500facility $87professional $74

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
$64.57
Typical High
$87.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$70.79
Typical High
$128.82
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$60.26
Typical High
$218.78
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$31.62
Typical High
$47.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$91.20
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$83.18
Typical High
$151.36
Medcost
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$138.04
Medcost
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$97.72
Typical High
$162.18
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$208.93
Sentara
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$83.18
Typical High
$125.89
Sentara
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$109.65
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$112.20
Typical High
$169.82
United
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$87.10
Typical High
$147.91

Where Virginia 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.

Virginia· 36th of 51

$75.86

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.