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Illinois rates for HCPCS 99213

Office or other outpatient visit for the evaluation and management of an 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, 20 minutes must be met or exceeded.

Facilitymedian $148 · 10th–90th $48–$3310%10%10th90th$148Professionalmedian $87 · 10th–90th $52–$1860%10%10th90th$87$2.0$10.0$50.0$200.0$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
$46.77 / $102.33 / $302.00
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$60.26 / $181.97 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $85.11 / $181.97
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$52.48 / $87.10 / $194.98
Aetna
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$38.02 / $64.57 / $131.83
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $85.11 / $120.23
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$63.10 / $89.13 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $138.04 / $223.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $81.28 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $134.90 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $89.13 / $147.91
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $194.98
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
$69.18 / $83.18 / $112.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $89.13 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $91.20 / $169.82
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $95.50 / $138.04