Outpatient specialist consultation, high complexity visit

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC OFFICE CONSULT LEVEL 5

Payers reporting CPT 99245

Payer pricing summary

Low

$82

Average

$388

Median

$360

High

$823

Payer rate distribution

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#
1	Cigna fee schedule · outpatient · +30 other terms	79	$234	$415	$299	72%	1–10	$5 – $1.2k
2	Blue Cross Blue Shield fee schedule · outpatient · +31 other terms	165	$565	$574	$322	56%	—	$0 – $2.0k
3	UnitedHealthcare fee schedule · outpatient · +36 other terms	157	$208	$289	$182	63%	—	$1 – $1.4k
4	Humana fee schedule · outpatient · +24 other terms	154	$222	$381	$716	188%	—	$22 – $8.3k
5	Aetna fee schedule · outpatient · +30 other terms	132	$206	$513	$1.0k	198%	—	$20 – $8.4k
6	Anthem fee schedule · outpatient · +21 other terms	66	$201	$210	$71	34%	—	$21 – $771
7	Molina facility · case rate · outpatient · +23 other terms	38	$66	$158	$177	112%	—	$28 – $663
8	Kaiser fee schedule · outpatient · +17 other terms	34	$210	$250	$135	54%	—	$5 – $530
9	WellCare facility · fee schedule · outpatient · +17 other terms	31	$126	$158	$40	25%	—	$120 – $216
10	Caresource facility · case rate · outpatient · +10 other terms	26	$63	$78	$113	145%	—	$5 – $406
11	Medicaid fee schedule · outpatient · +8 other terms	25	$357	$328	$196	60%	—	$1 – $787
12	Bcbs Tx fee schedule · outpatient · +3 other terms	23	$811	$774	$238	31%	—	$226 – $1.3k
13	Devoted fee schedule · outpatient · +12 other terms	22	$206	$208	$2	1%	—	$203 – $211
14	Optum professional · fee schedule · outpatient · +18 other terms	21	$206	$165	$52	32%	—	$90 – $217
15	Medica fee schedule · outpatient · +17 other terms	19	$401	$479	$204	43%	—	$107 – $804
16	Tricare facility · fee schedule · outpatient · +15 other terms	19	$120	$1.8k	$8.7k	492%	—	$73 – $50k
17	Medicare fee schedule · outpatient · +11 other terms	18	$210	$210	—	—	—	$210 – $210
18	Highmark fee schedule · outpatient · +13 other terms	16	$212	$224	$72	32%	—	$153 – $746
19	Aetna Better Health fee schedule · outpatient · +10 other terms	15	$192	$206	$73	36%	—	$147 – $483
20	Ucare professional · fee schedule · outpatient · +12 other terms	14	$216	$211	$15	7%	—	$175 – $227
21	Amerihealth Caritas fee schedule · both · +6 other terms	13	$186	$173	$26	15%	—	$120 – $186
22	Bcbs Nj fee schedule · outpatient · +4 other terms	13	$91	$103	$42	41%	—	$91 – $249
23	Wellmark fee schedule · both · +12 other terms	13	$253	$253	—	—	—	$253 – $253
24	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$851	$603	$333	55%	—	$182 – $1.1k
25	Cigna Healthspring fee schedule · outpatient · +2 other terms	12	$205	$205	—	—	—	$205 – $205

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