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Established Patient Office Visit, High Complexity

Illinois rates for HCPCS 99215

This is the most involved type of office visit for a patient who has already been seen by that practice, used when the medical decision-making is complex, such as managing multiple serious conditions or higher-risk treatment decisions. It reflects a high degree of complexity in the medical decisions made, or a longer amount of time spent with the patient during that visit. It differs from more routine follow-up visits mainly by that greater complexity or time.

Rates data updated July 2026.

How much does Established Patient Office Visit, High Complexity cost?

$166

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $195 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$166$126 to $229
FacilityA hospital or hospital-owned outpatient department$195$129 to $363

How much rates vary

Facilitymedian $195 · 10th to 90th $102 to $407Professionalmedian $166 · 10th to 90th $98 to $363
$50$100$200$500$1Kfacility $195professional $166

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$194.98
Typical High
$407.38
Aetna
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$194.98
Median
$407.38
Typical High
$501.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$165.96
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$208.93
Typical High
$512.86
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$173.78
Typical High
$257.04
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$138.04
Median
$186.21
Typical High
$257.04
BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$239.88
Typical High
$489.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$165.96
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$144.54
Typical High
$169.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$181.97
Typical High
$295.12
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$229.09
Typical High
$398.11
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$239.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$125.89
Typical High
$190.55
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$204.17
Typical High
$346.74
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$323.59
Typical High
$407.38

Where Illinois sits

The same service costs 1.8 times more in Minnesota than in Washington, DC. 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· 18th of 51

$166

MN $219DC $123

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.