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Comprehensive Specialist Consultation Visit

Ohio 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 $155 · 10th–90th $129$2690%20%40%10th90th$155Professionalmedian $186 · 10th–90th $135$2880%20%10th90th$186$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
$128.82
Median
$154.88
Typical High
$269.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$269.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$316.23
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$288.40
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$234.42
Typical High
$323.59
CareSource
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$234.42
CareSource
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$213.80
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$251.19
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$234.42
Typical High
$407.38
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$239.88
Typical High
$416.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$131.83
Typical High
$194.98
Optum
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$223.87
Typical High
$426.58
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$239.88
Typical High
$407.38
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$186.21
Typical High
$251.19
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$223.87
Typical High
$416.87