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Comprehensive Specialist Consultation Visit

New Jersey 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 October 2026.

How much does Comprehensive Specialist Consultation Visit cost?

$166

Typical physician fee. In New Jersey, October 2026.

Insurers have agreed to pay about $166 for this service. Most negotiated rates run $145 to $204.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $151 · 10th to 90th $126 to $204Professionalmedian $166 · 10th to 90th $126 to $251
$100$200$500facility $151professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$151.36
Typical High
$204.17
Aetna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$154.88
Typical High
$204.17
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$70.79
Median
$85.11
Typical High
$102.33
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$21.38
Median
$25.70
Typical High
$30.20
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$14.13
Median
$16.98
Typical High
$20.42
Ambetter
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$213.80
Typical High
$288.40
Cigna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$194.98
Typical High
$331.13
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$147.91
Typical High
$316.23
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$223.87
Typical High
$363.08
United
Setting
Professional
Modifier
None
Typical Low
$131.83
Median
$162.18
Typical High
$223.87

Where New Jersey sits

The same service costs 2.4 times more in Alaska than in Alabama. 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.

New Jersey· 50th of 51

$166

AK $380AL $158

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.