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Comprehensive Specialist Consultation Visit

Wisconsin 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 $219 · 10th–90th $166$4170%10%10th90th$219Professionalmedian $209 · 10th–90th $138$6030%10%10th90th$209$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
$138.04
Median
$186.21
Typical High
$467.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$288.40
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$257.04
Typical High
$512.86
CareSource
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$204.17
Typical High
$234.42
CareSource
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$251.19
Typical High
$295.12
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
$331.13
Typical High
$602.56
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$389.05
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$436.52
Typical High
$562.34
Medica
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$426.58
Medica
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$407.38
Typical High
$1,348.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$64.57
Typical High
$288.40
Network Health
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$416.87
Typical High
$645.65
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$218.78
Typical High
$389.05
Quartz
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$416.87
Typical High
$630.96
Quartz
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$1,148.15
Quartz
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$436.52
Typical High
$1,348.96
Security Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$407.38
Security Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$501.19
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$169.82
Typical High
$263.03
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$457.09
Typical High
$676.08