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Michigan rates for HCPCS 99213

Office or other outpatient visit for the evaluation and management of an 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, 20 minutes must be met or exceeded.

Facilitymedian $78 · 10th–90th $51$2570%10%10th90th$78Professionalmedian $87 · 10th–90th $52$1950%10%10th90th$87$2.0$10.0$50.0$200.0

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
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $74.13 / $173.78
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$47.86 / $158.49 / $537.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $87.10 / $190.55
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$52.48 / $89.13 / $199.53
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $263.03 / $263.03
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $77.62 / $117.49
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$63.10 / $87.10 / $131.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $93.33 / $97.72
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $93.33 / $114.82
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $112.20
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $112.20 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $147.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $74.13 / $165.96
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $74.13 / $117.49
Health Alliance Plan
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$66.07 / $165.96 / $426.58
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $79.43 / $169.82
Health Alliance Plan
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$52.48 / $89.13 / $199.53
Health Alliance Plan
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$123.03 / $123.03 / $263.03
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $147.91
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $112.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $54.95 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $75.86 / $151.36
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $91.20 / $144.54