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Specialist Office Consultation

Montana rates for HCPCS 99243

This service covers an office visit where a specialist reviews a patient's specific health problem at the request of another treating clinician and provides an opinion or recommendation. It involves a detailed review of the person's history and a focused examination, along with medical decision-making of low complexity. A written report is typically sent back to the requesting clinician.

Rates data updated July 2026.

How much does Specialist Office Consultation cost?

$120

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $112 from a physician practice, and about $158 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 5 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$112$89.13 to $145
FacilityA hospital or hospital-owned outpatient department$158$129 to $191

How much rates vary

Facilitymedian $158 · 10th to 90th $98 to $209Professionalmedian $112 · 10th to 90th $66 to $209
$5.0$10.0$20.0$50.0$100.0$200.0$500.0facility $158professional $112

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
$63.10
Median
$107.15
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$138.04
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$125.89
Typical High
$204.17
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$204.17
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$177.83
Typical High
$204.17
Providence
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$138.04
Typical High
$234.42
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$173.78
Typical High
$316.23
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$158.49
Typical High
$223.87

Where Montana sits

Rates are fairly even across states for this service. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Montana $120 · 11th of 51
MN $145WV $97.72

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.