What otolaryngology actually earns in Illinois
Not the sticker rates: what UnitedHealthcare and Cigna have really negotiated for the codes your practice bills, turned into dollars per year for a working case mix, from the payers’ own federal transparency filings.
What this means in dollars per year
Seeded with typical solo-provider volumes for otolaryngology in Illinois. Edit the volumes to match your practice; every figure recalculates.
Contract spread: $167,672 at the 25th percentile to $581,869 at the 75th
Contract spread: $334,051 at the 25th percentile to $469,258 at the 75th
Medicare pays $430,885 for the same year of work (3 of 3 codes have published Medicare rates).
Payer gap, same work
$32,039 / yr
Cigna’s published medians against UnitedHealthcare’s for this exact case mix. Which panels you prioritise is a revenue decision.
Negotiation room
$414,196 / yr
The swing between a bottom-quartile and top-quartile Cigna contract on this case mix. Practices at both ends bill the same codes; the difference is the contract, and contracts get renegotiated.
Figures use each payer’s published negotiated rates from federal Transparency in Coverage files, office place of service, and your volumes above. Published rates are benchmarks, not a guarantee of any practice’s contract.
Negotiate where the room is
The widest contract spreads here are 99214 ($145.58 per visit between quartiles), 99215 ($132.09 per visit between quartiles) and 99213 ($91.63 per visit between quartiles). Wide spread means payers demonstrably sign at very different rates, which makes those codes the renegotiation targets.
Treat below-Medicare as a decision
2 of 3 codes here pay under Medicare even at the best published median. A commercial contract below Medicare is not a billing problem to fix; it is a panel worth repricing or reconsidering.
Audit posting against these
Pull last month’s remittances for these codes and compare the allowed amounts to the medians below. Paid consistently under the 25th percentile means either a weak contract or a fee schedule loaded wrong, and both are findable in an afternoon.
Code by code
| CPT | UnitedHealthcare | Cigna | Medicare | Best vs Medicare | Room per visit |
|---|---|---|---|---|---|
| 99215 | $167.61 | $220.67 | $196.01 | 113% | $132.09 |
| 99214 | $123.92 | $129.89 | $137.84 | 94% | $145.58 |
| 99213 | $84.52 | $88.70 | $96.44 | 92% | $91.63 |
Medians per code, office place of service. “Room per visit” is the spread between the 25th and 75th percentile of real signed contracts at the widest payer, the range practices like yours actually landed in. Method at our rates methodology.
2 of these 3 codes pay below Medicare in Illinois even at the best published median. If your contract sits under these figures, the gap is contractual rather than a billing problem, and no amount of clean claims closes it.
Want the same math run on your actual remittances?
We compare what your payers allowed last quarter against these published rates, code by code, and tell you which contracts are underpaying and by how much. No charge, no commitment.
Check your ratesOtolaryngology in other states
Other specialties in Illinois
These are negotiated rates, not payments. What reaches your account also depends on eligibility, medical necessity, bundling edits and whether the claim survives adjudication. Half the contracts in Illinois sit above the medians shown and half below; which half you are in is your contract, and contracts move.