go back

Comprehensive Specialist Consultation Visit

Massachusetts 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.

How much does Comprehensive Specialist Consultation Visit cost?

$219

Typical negotiated rate. In Massachusetts, July 2026.

Insurers have agreed to pay about $219 for this service. The price depends on where it is billed: about $214 from a physician practice, and about $224 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 7 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$214$174 to $295
FacilityA hospital or hospital-owned outpatient department$224$186 to $275

How much rates vary

Facilitymedian $224 · 10th to 90th $123 to $324Professionalmedian $214 · 10th to 90th $145 to $550
$20$50$100$200$500$1Kfacility $224professional $214

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
$186.21
Median
$245.47
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$199.53
Typical High
$549.54
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$1,148.15
Typical High
$1,148.15
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$263.03
Typical High
$776.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$457.09
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$158.49
Typical High
$281.84
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$218.78
Typical High
$331.13
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$338.84
Typical High
$537.03
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$1,148.15
Typical High
$1,148.15
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$263.03
Typical High
$776.25
United
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$173.78
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$275.42
Typical High
$549.54

Where Massachusetts sits

The same service costs 1.5 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.

Massachusetts· 6th of 51

$219

MN $275WV $178

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.