go back

Illinois rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new 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, 60 minutes must be met or exceeded.

Facilitymedian $234 · 10th–90th $129–$4570%10%10th90th$234Professionalmedian $240 · 10th–90th $145–$5620%5%10%10th90th$240$5.0$20.0$100.0$500.0$2.0K

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
$128.82 / $229.09 / $338.84
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$190.55 / $269.15 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $229.09 / $537.03
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $309.03 / $691.83
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $309.03
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $223.87 / $302.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $602.56 / $630.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $208.93 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $141.25 / $162.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $239.88 / $389.05
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $288.40 / $575.44
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $251.19 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $213.80 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $239.88 / $436.52
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $91.20 / $457.09