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Montana rates for HCPCS G2212

Prolonged Office Or Other Outpatient Evaluation And Management Service(S) Beyond The Maximum Required Time Of The Primary Procedure Which Has Been Selected Using Total Time On The Date Of The Primary Service; Each Additional 15 Minutes By The Physician Or Qualified Healthcare Professional With Or Without Direct Patient Contact (List Separately In Addition To Cpt Codes 99205 99215 99483 For Office Or Other Outpatient Evaluation & Management Services(Desc Rvsd 1/1/23)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.33 / $31.07 / $65.44
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$93.45 / $93.45 / $93.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,099.99 / $68,099.99 / $81,499.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.01 / $48.90 / $51.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.90 / $48.90 / $51.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.57 / $48.90 / $51.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.64 / $31.02 / $47.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.60 / $57.66 / $83.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.62 / $56.26 / $64.03