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Montana rates for HCPCS 99243

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Facilitymedian $158 · 10th–90th $98–$2090%10%10th90th$158Professionalmedian $112 · 10th–90th $72–$2190%10%10th90th$112$5.0$10.0$20.0$50.0$100.0$200.0$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
$72.44 / $112.20 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $138.04 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $125.89 / $204.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $177.83 / $204.17
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $177.83 / $204.17
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $138.04 / $234.42
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $173.78 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $158.49 / $218.78