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Outpatient Specialist Consultation Visit

West 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?

$66.07

Typical negotiated rate. In West Virginia, July 2026.

Insurers have agreed to pay about $66.07 for this service. The price depends on where it is billed: about $66.07 from a physician practice, and about $57.54 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 4 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$66.07$50.12 to $97.72
FacilityA hospital or hospital-owned outpatient department$57.54$8.32 to $93.33

How much rates vary

Facilitymedian $58 · 10th to 90th $7 to $126Professionalmedian $66 · 10th to 90th $40 to $123
$5$10$20$50$100facility $58professional $66

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
$6.61
Median
$8.32
Typical High
$125.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$64.57
Typical High
$123.03
CareSource
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$57.54
Typical High
$69.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$72.44
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
$54.95
Median
$91.20
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$100.00
United
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$85.11
Typical High
$131.83

Where West 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.

West Virginia· 51st of 51

$66.07

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.