go back

Office Visit, Established Patient (Moderate Complexity)

Michigan rates for HCPCS 99214

A follow-up appointment with a doctor or other provider the patient has seen before, involving a moderate level of medical decision-making, such as managing several ongoing conditions or a condition that has changed and needs a closer look. It typically takes more time and involves more discussion and evaluation than a routine, simple check-in. The exact length varies, but it reflects a meaningful step up in complexity from the most basic follow-up visit.

Rates data updated July 2026.

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

$120

Typical negotiated rate. In Michigan, July 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $105 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$120$91.20 to $170
FacilityA hospital or hospital-owned outpatient department$105$81.28 to $132

How much rates vary

Facilitymedian $105 · 10th to 90th $58 to $229Professionalmedian $120 · 10th to 90th $69 to $263
$10$20$50$100$200$500facility $105professional $120

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
$52.48
Median
$102.33
Typical High
$229.09
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$61.66
Median
$134.90
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$123.03
Typical High
$269.15
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$61.66
Median
$125.89
Typical High
$288.40
Aetna
Setting
Professional
Modifier
50 · Both sides
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$112.20
Typical High
$169.82
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$83.18
Median
$125.89
Typical High
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$141.25
Typical High
$158.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$154.88
CareSource
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$117.49
Typical High
$162.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$162.18
Typical High
$169.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$109.65
Typical High
$239.88
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$144.54
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$165.96
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$239.88
Typical High
$457.09
United
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$120.23
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$109.65
Typical High
$245.47
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$120.23
Typical High
$199.53

Where Michigan sits

The same service costs 1.7 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· 24th of 51

$120

MN $148DC $89.13

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.