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Illinois rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, 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, 60 minutes must be met or exceeded.

Facilitymedian $195 · 10th–90th $107–$5250%10%10th90th$195Professionalmedian $174 · 10th–90th $117–$4470%10%10th90th$174$10.0$50.0$200.0$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
$107.15 / $147.91 / $275.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $446.68
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $134.90 / $302.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $676.08 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $190.55 / $295.12
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $234.42 / $524.81
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
$165.96 / $169.82 / $181.97
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $66.07 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $165.96 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $204.17 / $380.19