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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 July 2026.

How much does Comprehensive Specialist Consultation Visit cost?

$191

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $174 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 6 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$191$158 to $234
FacilityA hospital or hospital-owned outpatient department$174$145 to $251

How much rates vary

Facilitymedian $174 · 10th to 90th $100 to $1,349Professionalmedian $191 · 10th to 90th $135 to $331
$20$50$100$200$500$1Kfacility $174professional $191

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
$100.00
Median
$173.78
Typical High
$1,348.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$281.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$269.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$257.04
Typical High
$416.87
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$104.71
Typical High
$389.05
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$251.19
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$398.11

Where New Jersey 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.

New Jersey· 40th of 51

$191

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.