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Office Visit, Established Patient (Low Complexity)

Illinois rates for HCPCS 99213

A standard follow-up appointment with a doctor or other provider the patient has seen before, used for common, everyday medical concerns that require some evaluation and decision-making but aren't highly complex. It's one of the most frequently used visit levels for routine follow-ups, such as checking on a stable chronic condition or addressing a new but uncomplicated symptom. It sits between the most basic and more complex visit levels.

Rates data updated July 2026.

How much does Office Visit, Established Patient (Low Complexity) cost?

$87.10

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $87.10 for this service. The price depends on where it is billed: about $87.10 from a physician practice, and about $93.33 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 7 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$87.10$64.57 to $110
FacilityA hospital or hospital-owned outpatient department$93.33$57.54 to $170

How much rates vary

Facilitymedian $93 · 10th to 90th $47 to $204Professionalmedian $87 · 10th to 90th $52 to $174
$20$50$100$200facility $93professional $87

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$93.33
Typical High
$204.17
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$112.20
Median
$190.55
Typical High
$354.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$87.10
Typical High
$177.83
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$56.23
Median
$91.20
Typical High
$186.21
Aetna
Setting
Professional
Modifier
50 · Both sides
Typical Low
$64.57
Median
$75.86
Typical High
$97.72
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$85.11
Typical High
$125.89
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$63.10
Median
$91.20
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$177.83
Typical High
$223.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$81.28
Typical High
$102.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$134.90
Typical High
$158.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$89.13
Typical High
$144.54
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$109.65
Typical High
$194.98
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$83.18
Typical High
$112.20
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$100.00
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$95.50
Typical High
$169.82
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$91.20
Typical High
$138.04

Where Illinois sits

The same service costs 1.6 times more in Minnesota than in Washington, DC. 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.

Illinois· 12th of 51

$87.10

MN $97.72DC $61.66

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.