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Hospital Consultation, Lower Complexity

Illinois rates for HCPCS 99252

A specialist's opinion on a hospital patient, requested by the doctor already caring for them. The consultant takes a history, examines the patient, reviews the records, and writes back with advice. This is one of the shorter consultations of its kind, for a problem that is fairly limited in complexity.

Rates data updated July 2026.

How much does Hospital Consultation, Lower Complexity cost?

$100

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $100 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $85.11 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$100$69.18 to $129
FacilityA hospital or hospital-owned outpatient department$85.11$63.10 to $145

How much rates vary

Facilitymedian $85 · 10th to 90th $55 to $269Professionalmedian $100 · 10th to 90th $55 to $155
$50$100$200$500$1Kfacility $85professional $100

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
$54.95
Median
$74.13
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$100.00
Typical High
$154.88
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$69.18
Typical High
$199.53
BCBS
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$309.03
Typical High
$1,174.90
Cigna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$95.50
Typical High
$138.04
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$346.74
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
$85.11
Median
$87.10
Typical High
$93.33
Molina
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$33.88
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$100.00
Typical High
$173.78

Where Illinois sits

The same service costs 2.3 times more in South Dakota 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· 33rd of 51

$100

SD $158DC $67.61

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.