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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.

Facilitymedian $174 · 10th–90th $100$1,3490%10%10th90th$174Professionalmedian $191 · 10th–90th $135$3310%10%10th90th$191$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
$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