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Extended Preventive Counseling Visit

Illinois rates for HCPCS 99403

A clinician spends a substantial one-on-one session, roughly 45 minutes, counseling a patient on ways to reduce personal health risks, for example around diet, exercise, or other lifestyle factors, separate from a routine checkup. It is handled as its own visit rather than folded into another type of appointment. This length of session allows more in-depth discussion than a brief counseling conversation.

Rates data updated October 2026.

How much does Extended Preventive Counseling Visit cost?

$85.11

Typical negotiated rate. In Illinois, October 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $263 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$85.11$77.62 to $105
FacilityA hospital or hospital-owned outpatient department$263$135 to $646

How much rates vary

Facilitymedian $263 · 10th to 90th $69 to $1,096Professionalmedian $85 · 10th to 90th $68 to $120
$100$200$500$1Kfacility $263professional $85

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$66.07
Median
$69.18
Typical High
$95.50
Aetna
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$74.13
Typical High
$89.13
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$31.62
Median
$33.11
Typical High
$39.81
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$9.33
Median
$10.00
Typical High
$12.02
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$6.31
Median
$6.76
Typical High
$7.94
Ambetter
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$83.18
Typical High
$85.11
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$323.59
Typical High
$1,230.27
BCBS Illinois
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$83.18
Typical High
$109.65
Cigna
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$97.72
Typical High
$131.83
Hally Health
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$102.33
Typical High
$186.21
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$87.10
Typical High
$112.20
Molina
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$120.23
Typical High
$138.04
United
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$91.20
Typical High
$147.91

Where Illinois sits

The same service costs 2.9 times more in Alaska than in Florida. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Illinois· 30th of 51

$85.11

AK $186FL $64.57

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.