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Procedure price report · Consultation, evaluation, and preventative care

Specialist clinic consultation, straightforward visit

CPT 99242the billing code this page is about

An office or outpatient consultation requested by another provider, at the level involving a straightforward problem and a limited amount of physician time and decision-making.

Hospitals typically charge $125 cash for this outpatient procedure — the median across 957 hospitals that filed a usable cash price; the average of the middle 60% is $129. Most fall between $66 and $222 (20th–80th percentile).

Hospitals
957
States
48
Filings dated
Aug 2022 – Sep 2026
Computed
September 25, 2026
Prices checked
through September 24, 2026

Median: half of hospitals filed less, half more — and it is a price some hospital actually filed. Average of the middle 60%: the mean of the prices between the 20th and 80th percentiles. We never publish the plain average, the lowest or the highest price: the extremes in hospital price files are chargemaster artefacts, not prices anyone pays.

What hospitals charge, from cheapest to most expensive

Cash price percentiles, outpatient, across 957 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$45$77$125$194$316

The most expensive tenth of hospitals charges at least 7.1× what the cheapest tenth charges ($45 vs $316).

How the prices are spread

$35 – $45: 48 hospitals$35$45 – $57: 45 hospitals$57 – $72: 80 hospitals$57$72 – $92: 86 hospitals$92 – $117: 146 hospitals$92$117 – $148: 124 hospitals$148 – $189: 129 hospitals$148$189 – $240: 75 hospitals$240 – $305: 72 hospitals$240$305 – $388: 62 hospitals$305median $125price bands are equal on a log scale
Hospitals per price band (867 of 957 — the bands cover the 5th to 95th percentile)
FromToHospitals
$35$4548
$45$5745
$57$7280
$72$9286
$92$117146
$117$148124
$148$189129
$189$24075
$240$30572
$305$38862

By state

The median cash price in each state, against the national median of $125.

Alaska: median $309 across 11 hospitalsAK$309Maine: median $114 across 19 hospitalsME$114Vermont: median $161 across 11 hospitalsVT$161New Hampshire: 9 hospitals filed a usable price — fewer than 10, so no figureNHWashington: median $174 across 24 hospitalsWA$174Idaho: 5 hospitals filed a usable price — fewer than 10, so no figureIDMontana: median $163 across 16 hospitalsMT$163North Dakota: 6 hospitals filed a usable price — fewer than 10, so no figureNDMinnesota: median $143 across 44 hospitalsMN$143Illinois: median $120 across 45 hospitalsIL$120Wisconsin: median $142 across 53 hospitalsWI$142Michigan: median $108 across 39 hospitalsMI$108New York: median $242 across 54 hospitalsNY$242Massachusetts: median $152 across 11 hospitalsMA$152Oregon: median $136 across 13 hospitalsOR$136Nevada: 5 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 9 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 7 hospitals filed a usable price — fewer than 10, so no figureSDIowa: median $159 across 50 hospitalsIA$159Indiana: median $65 across 31 hospitalsIN$65Ohio: median $80 across 24 hospitalsOH$80Pennsylvania: median $148 across 46 hospitalsPA$148New Jersey: median $109 across 12 hospitalsNJ$109Connecticut: 8 hospitals filed a usable price — fewer than 10, so no figureCTRhode Island: no hospital in the corpus filed a usable priceRICalifornia: median $126 across 43 hospitalsCA$126Utah: 2 hospitals filed a usable price — fewer than 10, so no figureUTColorado: median $101 across 18 hospitalsCO$101Nebraska: median $149 across 16 hospitalsNE$149Missouri: median $96 across 36 hospitalsMO$96Kentucky: median $65 across 20 hospitalsKY$65West Virginia: median $62 across 19 hospitalsWV$62Virginia: 7 hospitals filed a usable price — fewer than 10, so no figureVAMaryland: 3 hospitals filed a usable price — fewer than 10, so no figureMDDelaware: no hospital in the corpus filed a usable priceDEArizona: median $133 across 13 hospitalsAZ$133New Mexico: 4 hospitals filed a usable price — fewer than 10, so no figureNMKansas: median $126 across 34 hospitalsKS$126Arkansas: median $101 across 13 hospitalsAR$101Tennessee: median $66 across 10 hospitalsTN$66North Carolina: median $108 across 11 hospitalsNC$108South Carolina: median $153 across 14 hospitalsSC$153Oklahoma: median $94 across 20 hospitalsOK$94Louisiana: 7 hospitals filed a usable price — fewer than 10, so no figureLAMississippi: median $72 across 17 hospitalsMS$72Alabama: 8 hospitals filed a usable price — fewer than 10, so no figureALGeorgia: median $98 across 24 hospitalsGA$98Hawaii: median $82 across 10 hospitalsHI$82Texas: median $104 across 34 hospitalsTX$104Florida: median $107 across 22 hospitalsFL$107
Cash price by state, most expensive first. National median $125. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
Alaska AK11$309+147%$229 – $361
New York NY54$242+94%$80 – $340
Washington WA24$174+40%$115 – $240
Montana MT16$163+30%$50 – $255
Vermont VT11$161+29%$109 – $204
Iowa IA50$159+27%$76 – $178
South Carolina SC14$153+22%$113 – $153
Massachusetts MA11$152+22%$85 – $322
Nebraska NE16$149+20%$105 – $224
Pennsylvania PA46$148+18%$43 – $243
Minnesota MN44$143+14%$109 – $203
Wisconsin WI53$142+14%$114 – $253
Oregon OR13$136+9%$108 – $165
Arizona AZ13$133+7%$86 – $153
California CA43$126+1%$38 – $288
Kansas KS34$126+1%$98 – $169
Illinois IL45$120−4%$65 – $221
Maine ME19$114−9%$33 – $279
New Jersey NJ12$109−13%$42 – $612
Michigan MI39$108−13%$55 – $136
North Carolina NC11$108−13%$53 – $137
Florida FL22$107−14%$61 – $309
Texas TX34$104−16%$61 – $210
Colorado CO18$101−19%$57 – $256
Arkansas AR13$101−19%$47 – $140
Georgia GA24$98−21%$78 – $290
Missouri MO36$96−23%$66 – $163
Oklahoma OK20$94−25%$68 – $108
Hawaii HI10$82−34%$57 – $83
Ohio OH24$80−36%$52 – $237
Mississippi MS17$72−43%$39 – $128
Tennessee TN10$66−47%$62 – $79
Indiana IN31$65−48%$48 – $177
Kentucky KY20$65−48%$45 – $98
West Virginia WV19$62−50%$25 – $161
New Hampshire NH9not enough hospitals filed a usable price
Wyoming WY9not enough hospitals filed a usable price
Alabama AL8not enough hospitals filed a usable price
Connecticut CT8not enough hospitals filed a usable price
Louisiana LA7not enough hospitals filed a usable price
South Dakota SD7not enough hospitals filed a usable price
Virginia VA7not enough hospitals filed a usable price
North Dakota ND6not enough hospitals filed a usable price
Idaho ID5not enough hospitals filed a usable price
Nevada NV5not enough hospitals filed a usable price
New Mexico NM4not enough hospitals filed a usable price
Maryland MD3not enough hospitals filed a usable price
Utah UT2not enough hospitals filed a usable price

Hospitals like yours

The same distribution cut by the kind of hospital. Hospital type and ownership come from CMS; a hospital counts as part of a system when its price file is shared with at least one other hospital under the same brand. The national median is $125.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care549$114$65 – $227
Children’s31$172$96 – $320
Critical access375$137$71 – $214
Ownership
For-profit56$98$65 – $191
Government247$122$78 – $217
Non-profit652$127$64 – $243
System affiliation
Part of a system680$124$63 – $217
Independent277$128$79 – $240

Cash price vs list price

Median list price (chargemaster)$200
Median cash price$125
Cash as a share of list, median hospital65%

At the typical hospital, asking for the cash price cuts the list price by about 35%. The share is the median of each hospital’s own cash ÷ list ratio, over hospitals that filed both — not the ratio of the two medians above.

The same procedure, inpatient

563 hospitals filed a usable inpatient cash price for this code. The median is $134 and the average of the middle 60% is $135; most fall between $75 and $229.

Cash price percentiles, inpatient, across 563 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$55$85$134$196$318

The most expensive tenth of hospitals charges at least 5.8× what the cheapest tenth charges ($55 vs $318).

Of the 607 hospitals that filed this code inpatient, 563 gave a usable cash price; 2 carried a plausibility flag, 0 filed a number their own filing marks as not a price, 0 gave an estimate, and 42 a list price only.

How complete is this

957 of the 3,956 hospitals with a price file in our corpus (24%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 1,052 hospitals that filed this code at all gave us
Usable cash price — counted957
Cash price carrying a plausibility flag — shown on the compare tool, excluded here22
A number the filing itself marks as not a price (a placeholder, a ratio) — excluded0
An estimate rather than a filed cash price — excluded0
A list price only, no cash figure — excluded73
Hospitals that filed this code1,052

Sections not shown for this setting

  • Against Medicare: Medicare has no separately payable national outpatient (OPPS) rate for this code, so there is nothing honest to compare against.
  • Since our last snapshot: there is no earlier snapshot at least 90 days older than this one yet.

We last checked these hospitals’ price files for changes between July 20, 2026 and September 24, 2026; the figures were computed September 25, 2026 from filings loaded through September 24, 2026. The percentiles and averages use only the “counted” row.

Related procedures

Part of the Consultation, evaluation, and preventative care family.

Hospitals file this code under descriptions such as Office/OP Consltj New/Est Pt Sf Mdm 20 Minutes.

Method

Source
The machine-readable price files every U.S. hospital is required by CMS to publish, parsed per hospital. Nothing is surveyed, sampled or modelled.
What counts
One cash (self-pay) price per hospital for this code and setting. A hospital’s own filing can rule its number out — a placeholder, a “not applicable” note, a list price standing in for cash — and our plausibility checks can flag a price far below what every other hospital files. Both kinds are disclosed above and excluded from the statistics; on the compare tool a flagged price is still shown.
Statistics
Percentiles are discrete: each is a price some hospital filed. The average is the mean of the prices between the 20th and 80th percentiles. We never publish the plain mean, the minimum or the maximum. A state needs 10 hospitals and a segment 20 to show a figure; otherwise the row shows its count and no number. Medicare is the national unadjusted OPPS rate where one exists.
Names
Procedure names on these pages are our own plain-language titles, not the AMA’s copyrighted CPT descriptors. The code is the identity.

The full rules — sources, statistics, thresholds, limitations — are on the methodology page.

Download this page’s figures: JSON · CSV. Aggregates only — the per-hospital prices are on the compare tool.

Cite: HospitalRates.com, “Specialist clinic consultation, straightforward visit (CPT 99242) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-99242-specialist-clinic-consultation-straightforward-visit