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Montana rates for HCPCS 99242

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $112 · 10th–90th $69–$1550%10%10th90th$112Professionalmedian $95 · 10th–90th $48–$1780%5%10%10th90th$95$5.0$20.0$100.0$500.0

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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $93.33 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $87.10 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $87.10 / $138.04
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $117.49 / $147.91
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $117.49 / $147.91
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $102.33 / $177.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $120.23 / $208.93
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $112.20 / $158.49