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Comprehensive Specialist Consultation Visit

New York 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 $195 · 10th–90th $89$2450%20%10th90th$195Professionalmedian $191 · 10th–90th $141$4370%20%10th90th$191$0.0$0.2$2.0$20.0$200.0

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
$194.98
Typical High
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$389.05
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$331.13
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$309.03
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
$275.42
Typical High
$501.19
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$229.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$104.71
Typical High
$389.05
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$204.17
Typical High
$436.52
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.03
Median
$0.04
Typical High
$257.04
Optum
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$234.42
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$141.25
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$173.78
Typical High
$602.56
Univera
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$158.49
Typical High
$407.38
Univera
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$204.17
Typical High
$416.87