go back

Comprehensive Specialist Consultation Visit

Illinois rates for HCPCS 99245

This is an in-depth office visit where a specialist evaluates a patient at the request of another provider, involving a thorough review of the patient's history, a detailed examination, and complex medical decision-making. It represents the most involved level of this type of consultation, typically used for patients with complicated or multiple medical problems. A written report is usually sent back to the referring provider afterward.

Rates data updated July 2026.

How much does Comprehensive Specialist Consultation Visit cost?

$195

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $195 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $295 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$195$166 to $234
FacilityA hospital or hospital-owned outpatient department$295$186 to $363

How much rates vary

Facilitymedian $295 · 10th to 90th $158 to $427Professionalmedian $195 · 10th to 90th $138 to $331
$20$50$100$200$500facility $295professional $195

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
$158.49
Median
$295.12
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$281.84
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$371.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$436.52
Median
$549.54
Typical High
$741.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$269.15
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$257.04
Typical High
$389.05
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$288.40
Typical High
$758.58
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
$218.78
Median
$223.87
Typical High
$275.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$93.33
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$134.90
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$269.15
Typical High
$436.52

Where Illinois sits

The same service costs 1.5 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· 30th of 51

$195

MN $275WV $178

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.