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Comprehensive Specialist Consultation Visit

North Carolina 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 $257 · 10th–90th $182$4370%10%10th90th$257Professionalmedian $263 · 10th–90th $158$5130%5%10%10th90th$263$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$181.97
Median
$213.80
Typical High
$549.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$204.17
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$302.00
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$354.81
Typical High
$512.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$436.52
Medcost
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$269.15
Typical High
$398.11
Medcost
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$389.05
Medcost
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$173.78
Typical High
$549.54
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$229.09
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$141.25
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$218.78
Typical High
$371.54
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,348.96
Median
$1,348.96
Typical High
$1,348.96