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Office Visit, Established Patient (Low Complexity)

Michigan rates for HCPCS 99213

A standard follow-up appointment with a doctor or other provider the patient has seen before, used for common, everyday medical concerns that require some evaluation and decision-making but aren't highly complex. It's one of the most frequently used visit levels for routine follow-ups, such as checking on a stable chronic condition or addressing a new but uncomplicated symptom. It sits between the most basic and more complex visit levels.

Rates data updated July 2026.

How much does Office Visit, Established Patient (Low Complexity) cost?

$85.11

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $75.86 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 8 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$85.11$64.57 to $110
FacilityA hospital or hospital-owned outpatient department$75.86$64.57 to $95.50

How much rates vary

Facilitymedian $76 · 10th to 90th $51 to $115Professionalmedian $85 · 10th to 90th $51 to $174
$20$50$100$200facility $76professional $85

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
$51.29
Median
$75.86
Typical High
$114.82
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$117.49
Median
$199.53
Typical High
$263.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$87.10
Typical High
$177.83
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$53.70
Median
$91.20
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$117.49
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$89.13
Typical High
$134.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$85.11
Typical High
$93.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$93.33
Typical High
$114.82
CareSource
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$79.43
Typical High
$109.65
CareSource
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$114.82
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$74.13
Typical High
$165.96
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$69.18
Typical High
$93.33
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$69.18
Typical High
$114.82
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$169.82
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$109.65
Typical High
$144.54
United
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$79.43
Typical High
$165.96
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$91.20
Typical High
$144.54

Where Michigan sits

The same service costs 1.6 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.

Michigan· 21st of 51

$85.11

MN $97.72DC $61.66

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.