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Office Visit, New Patient (High Complexity)

Montana rates for HCPCS 99205

An initial, in-depth appointment with a doctor or provider the patient has not seen before, involving a high level of medical decision-making, such as managing multiple serious conditions or health issues that carry significant risk. It's the most involved level of a first-time office visit and typically takes considerably more time than a routine new-patient appointment. It reflects the most complex end of new-patient evaluations.

Rates data updated July 2026.

How much does Office Visit, New Patient (High Complexity) cost?

$257

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $257 for this service. The price depends on where it is billed: about $257 from a physician practice, and about $295 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$257$191 to $398
FacilityA hospital or hospital-owned outpatient department$295$224 to $347

How much rates vary

Facilitymedian $295 · 10th to 90th $170 to $398Professionalmedian $257 · 10th to 90th $158 to $708
$100$200$500$1Kfacility $295professional $257

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$251.19
Typical High
$724.44
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$257.04
Typical High
$707.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$295.12
Typical High
$346.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$281.84
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$239.88
Typical High
$446.68
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$323.59
Typical High
$389.05
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$323.59
Typical High
$389.05
Providence
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$234.42
Typical High
$416.87
Providence
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$331.13
Typical High
$588.84
United
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$281.84
Typical High
$380.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$91.20
Typical High
$269.15

Where Montana sits

The same service costs 1.7 times more in Minnesota than in Delaware. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 4th of 51

$257

MN $295DE $174

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.