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Comprehensive Specialist Consultation Visit

Pennsylvania 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 $21 · 10th–90th $10$4270%10%20%10th90th$21Professionalmedian $195 · 10th–90th $123$4570%20%10th90th$195$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$10.00
Median
$21.38
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$194.98
Typical High
$467.74
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$380.19
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$229.09
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$239.88
Typical High
$363.08
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$398.11
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$426.58
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$288.40
Typical High
$575.44
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
Johns Hopkins Employer Health Plan
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Johns Hopkins Employer Health Plan
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$323.59
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$10.72
Median
$21.38
Typical High
$416.87
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$194.98
Typical High
$407.38
Optum
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$234.42
Typical High
$281.84
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$223.87
Typical High
$281.84
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$354.81
Typical High
$562.34
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$251.19
United
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$125.89
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$223.87
Typical High
$380.19