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Illinois rates for HCPCS 99235

Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.

Facilitymedian $209 · 10th–90th $102–$4270%10%10th90th$209Professionalmedian $269 · 10th–90th $170–$5620%10%10th90th$269$100.0$200.0$500.0$1.0K$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
$102.33 / $177.83 / $263.03
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$158.49 / $158.49 / $158.49
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $616.60 / $2,290.87
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $562.34
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $213.80