Medical Procedure Costs in Illinois
Illinois Medicare physician rates are generally near the national average. CMS uses 4 localities here, so a ZIP matters.
Look up any CPT in Illinois
Featured table below is 59 procedures. Search covers 7,500+ fee-schedule codes.
What these numbers are
Every figure on this page is a 2026 Medicare allowed amount: the physician line comes from the Physician Fee Schedule adjusted by geographic practice-cost indices, and the facility totals come from the CMS hospital outpatient (OPPS) and ambulatory surgery centre rates. None of them is a hospital chargemaster price, your insurer's contracted rate, or a quote. Anesthesia, pathology, imaging reads and follow-up care are billed under their own codes when they apply, and an inpatient stay is paid a different way again. These Illinois averages are unweighted means of the state’s localities, not population-weighted.
How Medicare prices Illinois
Illinois uses one of the more detailed locality maps in the Midwest: Chicago has its own locality, the suburban collar counties are priced separately, the East St. Louis area carries its own locality tied to the St. Louis market, and the rest of the state shares a fourth. Approved amounts step down noticeably from the city and suburbs to downstate, so the same procedure prices differently in Chicago, Naperville, Belleville, and Springfield. This four-way split makes Illinois one of the states where a ZIP-level check genuinely changes the answer. Downstate rates align more closely with neighboring rural states than with Chicagoland.
Chicago is one of the country's great medical hubs, with multiple academic medical centers and deep specialist supply, and its suburbs support large competing systems of their own. Downstate Illinois is a different market: smaller cities like Peoria, Springfield, and Champaign serve wide rural areas, and the Metro East suburbs orient toward St. Louis providers. Where you sit on that map shapes both price and choice.
Enter a ZIP code to see which Illinois locality applies to you, whether Chicago proper, the suburban collar counties, the Metro East near St. Louis, or downstate cities like Springfield, Peoria, and Champaign.
Illinois payment localities (GPCI)
| Locality | Work | PE |
|---|---|---|
| chicago | 1.007 | 1.005 |
| east st. louis | 1.000 | 0.920 |
| suburban chicago | 1.007 | 1.027 |
| rest of illinois | 1.000 | 0.913 |
GPCI of 1.000 equals the national average. Higher PE GPCI raises office-based procedures more than hospital physician lines.
Featured physician rates in Illinois
Office (non-facility) physician rates. Open a row for the locality table and ZIP tool.
Other states
Medical costs in Illinois: questions
Across the 59 featured procedures on this page, Illinois sits near the national average. Examples: incision & drainage of abscess $130, skin biopsy (tangential) $95, skin biopsy (punch) $121. Search any other CPT in the box above — those codes are in the tool, not as extra Illinois articles.
Illinois has 4 payment localities. Practice-expense GPCI runs from 0.913 to 1.027 (1.000 is the national average). Enter a ZIP code to see which Illinois locality applies to you, whether Chicago proper, the suburban collar counties, the Metro East near St. Louis, or downstate cities like Springfield, Peoria, and Champaign.
Medicare physician allowed amounts only — the professional fee after GPCI. They do not include hospital facility charges, anesthesia, or your plan’s contracted rate. Medicare patients typically owe 20% of the allowed amount after the Part B deductible, before Medigap.
Yes. The table is the featured set (59 procedures). The search box looks up 7,500+ payable codes from the 2026 fee schedule and applies Illinois’s locality when you enter a ZIP.