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Illinois rates for HCPCS 99243

Office or other outpatient consultation for a new or 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, 30 minutes must be met or exceeded.

Facilitymedian $148 · 10th–90th $78–$2240%20%10th90th$148Professionalmedian $112 · 10th–90th $72–$2290%10%10th90th$112$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
$77.62 / $147.91 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $109.65 / $218.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$239.88 / $269.15 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $151.36 / $186.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $134.90 / $213.80
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $151.36 / $407.38
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
$107.15 / $109.65 / $147.91
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $51.29 / $162.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $144.54 / $223.87