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Comprehensive Specialist Consultation Visit

Michigan rates for HCPCS 99245

This is an in-depth office visit where a specialist evaluates a patient at the request of another provider, involving a thorough review of the patient's history, a detailed examination, and complex medical decision-making. It represents the most involved level of this type of consultation, typically used for patients with complicated or multiple medical problems. A written report is usually sent back to the referring provider afterward.

Rates data updated October 2026.

How much does Comprehensive Specialist Consultation Visit cost?

$204

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $204 for this service. The price depends on where it is billed: about $204 from a physician practice, and about $195 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$204$178 to $229
FacilityA hospital or hospital-owned outpatient department$195$191 to $229

How much rates vary

Facilitymedian $195 · 10th to 90th $166 to $575Professionalmedian $204 · 10th to 90th $166 to $275
$200$500facility $195professional $204

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$147.91
Median
$194.98
Typical High
$229.09
Aetna
Setting
Professional
Modifier
None
Typical Low
$147.91
Median
$194.98
Typical High
$229.09
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$97.72
Median
$97.72
Typical High
$114.82
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$29.51
Median
$29.51
Typical High
$33.88
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$19.50
Median
$19.50
Typical High
$22.91
Ambetter
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$331.13
Typical High
$363.08
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$263.03
Median
$275.42
Typical High
$275.42
CareSource
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$263.03
Typical High
$309.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$223.87
Typical High
$281.84
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$165.96
Median
$229.09
Typical High
$630.96
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$204.17
Typical High
$263.03
Health Alliance Plan
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$97.72
Median
$97.72
Typical High
$112.20
Health Alliance Plan
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$29.51
Median
$29.51
Typical High
$33.88
Health Alliance Plan
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$19.50
Median
$19.50
Typical High
$22.91
Priority Health
Setting
Professional
Modifier
None
Typical Low
$177.83
Median
$223.87
Typical High
$263.03
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$218.78
Typical High
$251.19

Where Michigan sits

The same service costs 2.4 times more in Alaska than in Alabama. 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· 28th of 51

$204

AK $380AL $158

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.