go back

Outpatient Specialist Consultation Visit

Vermont 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?

$107

Typical physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $107 for this service. Most negotiated rates run $87.10 to $135.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $100 · 10th to 90th $78 to $115Professionalmedian $107 · 10th to 90th $66 to $257
$5$10$20$50$100$200facility $100professional $107

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
$87.10
Median
$102.33
Typical High
$114.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$104.71
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$158.49
Typical High
$158.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$100.00
Typical High
$141.25
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$0.03
Typical High
$109.65
United
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$79.43
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$97.72
Typical High
$186.21

Where Vermont 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.

Vermont· 4th of 51

$107

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.