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Illinois rates for HCPCS 99242

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $105 · 10th–90th $49–$1380%10%20%10th90th$105Professionalmedian $83 · 10th–90th $48–$1620%5%10th90th$83$5.0$10.0$20.0$50.0$100.0$200.0$500.0

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
$48.98 / $104.71 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $81.28 / $154.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $72.44 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $177.83 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $93.33 / $147.91
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $102.33 / $331.13
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
$66.07 / $69.18 / $97.72
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $39.81 / $107.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $72.44 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $147.91