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Office Visit, Established Patient (Moderate Complexity)

Illinois rates for HCPCS 99214

A follow-up appointment with a doctor or other provider the patient has seen before, involving a moderate level of medical decision-making, such as managing several ongoing conditions or a condition that has changed and needs a closer look. It typically takes more time and involves more discussion and evaluation than a routine, simple check-in. The exact length varies, but it reflects a meaningful step up in complexity from the most basic follow-up visit.

Rates data updated July 2026.

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

$120

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $120 for this service. The price depends on where it is billed: about $120 from a physician practice, and about $135 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$120$89.13 to $170
FacilityA hospital or hospital-owned outpatient department$135$85.11 to $219

How much rates vary

Facilitymedian $135 · 10th to 90th $62 to $282Professionalmedian $120 · 10th to 90th $68 to $263
$20$50$100$200$500$1Kfacility $135professional $120

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
$61.66
Median
$134.90
Typical High
$281.84
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$91.20
Median
$213.80
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$120.23
Typical High
$269.15
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$61.66
Median
$125.89
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$173.78
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$128.82
Typical High
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$138.04
Typical High
$331.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$114.82
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$134.90
Typical High
$158.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$208.93
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$158.49
Typical High
$269.15
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
$117.49
Median
$144.54
Typical High
$169.82
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$107.15
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$138.04
Typical High
$245.47
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$114.82
Typical High
$204.17

Where Illinois sits

The same service costs 1.7 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· 20th of 51

$120

MN $148DC $89.13

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.