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Michigan 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 $95 · 10th–90th $81–$1200%20%10th90th$95Professionalmedian $110 · 10th–90th $72–$2190%10%10th90th$110$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
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $95.50 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $107.15 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $151.36
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $144.54
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $112.20 / $151.36
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $138.04 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $120.23 / $199.53
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $120.23 / $138.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $199.53
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $117.49 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $104.71 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $204.17