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Outpatient Specialist Consultation Visit

Illinois rates for HCPCS 99242

In this type of visit, a doctor requests the opinion or advice of another physician or qualified health professional about a specific problem with a patient's care. The consulting clinician evaluates the patient and sends a written report back to the requesting doctor. This particular level involves a relatively limited amount of history-taking, examination, and decision-making compared to higher levels of the same type of visit.

Rates data updated July 2026.

How much does Outpatient Specialist Consultation Visit cost?

$77.62

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $77.62 from a physician practice, and about $97.72 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$77.62$57.54 to $110
FacilityA hospital or hospital-owned outpatient department$97.72$58.88 to $132

How much rates vary

Facilitymedian $98 · 10th to 90th $49 to $151Professionalmedian $78 · 10th to 90th $47 to $141
$10$20$50$100$200facility $98professional $78

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
$48.98
Median
$97.72
Typical High
$138.04
Aetna
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$74.13
Typical High
$138.04
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$72.44
Typical High
$186.21
BCBS
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$177.83
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$134.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$93.33
Typical High
$147.91
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$102.33
Typical High
$331.13
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
$66.07
Median
$69.18
Typical High
$97.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$39.81
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$100.00
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$100.00
Typical High
$154.88

Where Illinois sits

The same service costs 1.7 times more in Minnesota than in West Virginia. 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· 35th of 51

$77.62

MN $115WV $66.07

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.