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Established Patient Office Visit, High Complexity

Montana rates for HCPCS 99215

This is the most involved type of office visit for a patient who has already been seen by that practice, used when the medical decision-making is complex, such as managing multiple serious conditions or higher-risk treatment decisions. It reflects a high degree of complexity in the medical decisions made, or a longer amount of time spent with the patient during that visit. It differs from more routine follow-up visits mainly by that greater complexity or time.

Rates data updated July 2026.

How much does Established Patient Office Visit, High Complexity cost?

$191

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $224 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$191$135 to $275
FacilityA hospital or hospital-owned outpatient department$224$162 to $269

How much rates vary

Facilitymedian $224 · 10th to 90th $126 to $316Professionalmedian $191 · 10th to 90th $105 to $479
$50$100$200$500facility $224professional $191

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
Facility
Modifier
Global
Typical Low
$47.86
Median
$316.23
Typical High
$398.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$186.21
Typical High
$489.78
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$83.18
Median
$194.98
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$239.88
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$223.87
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$331.13
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$245.47
Typical High
$316.23
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$245.47
Typical High
$316.23
Providence
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$169.82
Typical High
$302.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$257.04
Typical High
$478.63
United
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$223.87
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$190.55
Typical High
$281.84

Where Montana sits

The same service costs 1.8 times more in Minnesota than in Washington, DC. 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· 3rd of 51

$191

MN $219DC $123

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.