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Michigan rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $195 · 10th–90th $166–$2290%20%10th90th$195Professionalmedian $195 · 10th–90th $145–$4070%10%10th90th$195$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$165.96 / $194.98 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $407.38
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $213.80 / $346.74
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $269.15
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $295.12
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $229.09 / $309.03
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $263.03 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $389.05
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $213.80 / $245.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $204.17 / $363.08
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $186.21 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $346.74