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Illinois rates for HCPCS 99245

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 55 minutes must be met or exceeded.

Facilitymedian $295 · 10th–90th $158–$4270%10%20%10th90th$295Professionalmedian $204 · 10th–90th $141–$4680%10%10th90th$204$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$158.49 / $295.12 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $199.53 / $446.68
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $371.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $549.54 / $741.31
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $269.15 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $257.04 / $398.11
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $288.40 / $758.58
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
$218.78 / $223.87 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $93.33 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $257.04 / $398.11