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Comprehensive Specialist Consultation Visit

California rates for HCPCS 99245

This is an in-depth office visit where a specialist evaluates a patient at the request of another provider, involving a thorough review of the patient's history, a detailed examination, and complex medical decision-making. It represents the most involved level of this type of consultation, typically used for patients with complicated or multiple medical problems. A written report is usually sent back to the referring provider afterward.

Rates data updated July 2026.

Facilitymedian $219 · 10th–90th $162$3800%20%10th90th$219Professionalmedian $219 · 10th–90th $148$7410%20%10th90th$219$0.0$0.2$2.0$20.0$200.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$194.98
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$213.80
Typical High
$758.58
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$213.80
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$199.53
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$251.19
Typical High
$416.87
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$87.10
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$100.00
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$257.04
Typical High
$436.52
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$102.33
Typical High
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$630.96
Typical High
$977.24
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$1,348.96
Typical High
$1,348.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$112.20
Typical High
$302.00
Optum
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$234.42
Typical High
$331.13
Providence
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$251.19
Typical High
$371.54
Providence
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$269.15
Typical High
$512.86
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$218.78
Typical High
$416.87