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Illinois rates for HCPCS 99252

Inpatient or observation 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, 35 minutes must be met or exceeded.

Facilitymedian $102 · 10th–90th $55–$2450%10%10th90th$102Professionalmedian $105 · 10th–90th $58–$1950%5%10th90th$105$5.0$20.0$100.0$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
$54.95 / $85.11 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $104.71 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $70.79 / $199.53
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $309.03 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $141.25
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $125.89 / $346.74
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
$85.11 / $87.10 / $93.33
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $33.88 / $93.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $141.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $151.36