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Comprehensive Specialist Consultation Visit

Texas 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 $240 · 10th–90th $138$4270%10%10th90th$240Professionalmedian $195 · 10th–90th $129$2750%10%10th90th$195$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
$117.49
Median
$138.04
Typical High
$204.17
Aetna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$190.55
Typical High
$269.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$208.93
Typical High
$323.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$489.78
Typical High
$1,000.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$229.09
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$229.09
Typical High
$316.23
Christus
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$407.38
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$870.96
Typical High
$1,348.96
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$407.38
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$302.00
Typical High
$407.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$194.98
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$213.80
Typical High
$281.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$245.47
Typical High
$407.38
Providence
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$446.68
United
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$158.49
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$218.78
Typical High
$346.74
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$281.84