Commercial healthcare reimbursement in Illinois
How Illinois compares with the nation, by payer, specialty and procedure.
Illinois at a glance
What the data shows
Illinois ranks 28th of 51 states for commercial reimbursement, with an index of 97 (100 = national median) across 228 procedure codes; the Midwest region averages 115.
Commercial rates in Illinois run a median 144% of Medicare.
UnitedHealthcare has the highest index in the state (133) and Blue Cross Blue Shield the lowest (86), a 47-point gap, in the files analyzed.
CPT 65820 (Goniotomy) is the strongest relative to the national median (122% of it, a 22% premium); CPT 51700 (Irrigation of bladder) is furthest below (78% of the national median, 22% lower).
By specialty, Illinois is strongest for dermatology (ranks 20th of 50 states for that specialty) and weakest for diagnostic radiology (47th of 51).
Against Medicare, gastroenterology has the highest ratio in Illinois (178% of Medicare) and dermatology the lowest (100%).
Payer ranking in Illinois
| Payer | Index | Rank | Level | Codes | Providers | TINs |
|---|---|---|---|---|---|---|
| UnitedHealthcare | 133 | 1 | 228 | 706 | 512 | |
| Cigna | 106 | 2 | 228 | 644 | 500 | |
| Aetna | 88 | 3 | 228 | 626 | 554 | |
| Blue Cross Blue Shield | 86 | 4 | 228 | 841 | 946 |
Reimbursement index by specialty in Illinois
| Specialty | Index | Rank among states | % of Medicare | Level | Codes | Providers |
|---|---|---|---|---|---|---|
| Dermatology | 106 | 20 of 50 | 100% | 44 | 114 | |
| Orthopedic surgery | 102 | 23 of 51 | 150% | 39 | 106 | |
| Ophthalmology | 99 | 24 of 50 | 121% | 42 | 112 | |
| Cardiology | 98 | 27 of 51 | 141% | 38 | 119 | |
| Urology | 98 | 28 of 50 | 157% | 37 | 108 | |
| Internal medicine | 94 | 31 of 51 | 109% | 25 | 89 | |
| Gastroenterology | 95 | 32 of 50 | 178% | 36 | 115 | |
| Diagnostic radiology | 84 | 47 of 51 | 132% | 49 | 126 |
Specialty by payer in Illinois
| Specialty | UHC | Aetna | Cigna | BCBS |
|---|---|---|---|---|
| Internal medicine | 131 | 78 | 102 | 81 |
| Dermatology | 150 | 96 | 99 | 94 |
| Ophthalmology | 120 | 84 | 115 | 90 |
| Cardiology | 126 | 90 | 106 | 81 |
| Orthopedic surgery | 125 | 98 | 109 | 85 |
| Diagnostic radiology | 129 | 73 | 101 | 50 |
| Urology | 127 | 87 | 106 | 79 |
| Gastroenterology | 127 | 78 | 104 | 77 |
Illinois compared with Midwest region states
Procedures that pay most and least in Illinois vs the nation
Highest vs national
| Code | Illinois | National | Gap | Prov. |
|---|---|---|---|---|
| 65820 Goniotomy | $1,164 | $955 | +22% | 111 |
| 36482 Endoven ther chem adhes 1st | $337 | $278 | +21% | 119 |
| 66984 Xcapsl ctrc rmvl w/o ecp | $892 | $738 | +21% | 111 |
| 36465 Njx noncmpnd sclrsnt 1 vein | $223 | $185 | +21% | 119 |
| 66991 Xcapsl ctrc rmvl insj 1+ | $997 | $840 | +19% | 111 |
| 66821 After cataract laser surgery | $463 | $393 | +18% | 111 |
| 93000 Electrocardiogram complete | $29 | $24 | +17% | 873 |
| 96413 Chemo iv infusion 1 hr | $238 | $204 | +16% | 115 |
| 67036 Removal of inner eye fluid | $1,296 | $1,117 | +16% | 111 |
| 93296 Rem interrog evl pm/ids | $45 | $39 | +16% | 119 |
| 96574 Dbrdmt prmlg les w/pdt | $364 | $315 | +16% | 113 |
| 37243 Vasc embolize/occlude organ | $991 | $858 | +15% | 122 |
| 65756 Corneal trnspl endothelial | $1,634 | $1,425 | +15% | 112 |
| 52356 Cysto/uretero w/lithotripsy | $741 | $657 | +13% | 106 |
| 67210 Treatment of retinal lesion | $733 | $659 | +11% | 111 |
Lowest vs national
| Code | Illinois | National | Gap | Prov. |
|---|---|---|---|---|
| 51700 Irrigation of bladder | $60 | $77 | -22% | 107 |
| 51720 Treatment of bladder lesion | $87 | $111 | -22% | 107 |
| 43239 Egd biopsy single/multiple | $276 | $349 | -21% | 115 |
| 72148 Mri lumbar spine w/o dye | $305 | $382 | -20% | 227 |
| 73721 Mri jnt of lwr extre w/o dye | $320 | $399 | -20% | 226 |
| 73221 Mri joint upr extrem w/o dye | $320 | $399 | -20% | 226 |
| 70551 Mri brain stem w/o dye | $323 | $402 | -20% | 123 |
| 52000 Cystourethroscopy | $169 | $210 | -20% | 107 |
| 71045 X-ray exam chest 1 view | $26 | $33 | -19% | 125 |
| 72131 Ct lumbar spine w/o dye | $200 | $248 | -19% | 124 |
| 72141 Mri neck spine w/o dye | $315 | $390 | -19% | 122 |
| 72125 Ct neck spine w/o dye | $204 | $249 | -18% | 123 |
| 52648 Laser surgery of prostate | $1,237 | $1,508 | -18% | 106 |
| 76536 Us exam of head and neck | $127 | $154 | -18% | 124 |
| 72158 Mri lumbar spine w/o & w/dye | $490 | $593 | -17% | 122 |
Frequently asked questions
How do commercial reimbursement rates in Illinois compare with the rest of the country?
Illinois ranks 28th of 51 states with an index of 97, across 228 procedure codes. Median commercial rates run 144% of the Medicare rate.
Which payer has the highest rates in Illinois?
In the files we analyzed, UnitedHealthcare has the highest index (133) and Blue Cross Blue Shield the lowest (86). Each payer's figures describe the specific plans and networks in the files used, not its whole book of business.
Which specialty has the strongest rates in Illinois?
Dermatology ranks 20th of 50 states.
How many providers does this Illinois page cover?
889 sampled providers across 4 payers. The data comes from a random sample of providers, so counts describe the sample, not every provider in the state.
Which procedures differ most between Illinois and the national median?
CPT 65820 (Goniotomy) is highest relative to the nation at 122% of the national median; CPT 51700 (Irrigation of bladder) is lowest at 78%.
Methodology
- Source: in-network negotiated-rate files published under the federal Transparency in Coverage rule, August 2026 snapshot: UnitedHealthcare Choice plans (74 files); Aetna commercial plans (70 files); Cigna national PPO (1 files); BCBS licensees' own-network files (5,387 files). Payer comparisons describe these files, not each payer's entire book of business.
- Sample: rates come from a random sample of up to 150 providers per state and specialty. Counts on this page are sampled providers and TINs, not totals.
- Which providers count: only providers in a specialty relevant to the code, because a rate in a payer file attaches to a provider group and is listed under every provider in that group.
- Filters: fee-for-service, professional billing class, no modifier, negotiated or fee-schedule dollar rates. Rates outside 1% to 1,000% of the Medicare rate are excluded.
- Statistic: one median rate per provider, then percentiles across providers. A cell is shown only with at least 15 sampled providers and 4 TINs.
- Medicare benchmark: CY2026 national physician fee schedule, non-QPP conversion factor, unadjusted for locality. Where the non-facility rate is more than twice the facility rate (office rates that include device or supply cost), the facility rate is used so comparisons are like for like.
Benchmark your Illinois contracts
Compare your negotiated rates with these state medians by payer and specialty.