How Much Does Critical care, first 30-74 minutes Cost?
Critical care, first 30-74 minutes (CPT 99291) costs $223 at Medicare rates. Hospital outpatient rate: $844.
Cost Comparison by Payer
How much Critical care, first 30-74 minutes costs across different settings and payers
Critical care, first 30-74 minutes Cost by Location
Medicare-adjusted rates across CMS localities
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA* | $299 | $449 — $749 |
| AL — ALABAMA | $214 | $320 — $534 |
| AR — ARKANSAS | $212 | $317 — $529 |
| AZ — ARIZONA | $225 | $338 — $563 |
| AZ — Phoenix | $228 | $342 — $570 |
| CA — BAKERSFIELD | $230 | $345 — $576 |
| CA — CHICO | $228 | $343 — $571 |
| CA — EL CENTRO | $228 | $343 — $571 |
| CA — FRESNO | $228 | $343 — $571 |
| CA — HANFORD-CORCORAN | $228 | $343 — $571 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $240 | $360 — $600 |
| CA — Los Angeles | $244 | $366 — $610 |
| CA — MADERA | $228 | $343 — $571 |
| CA — MERCED | $228 | $343 — $571 |
| CA — MODESTO | $228 | $343 — $571 |
| CA — NAPA | $248 | $372 — $619 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $237 | $355 — $592 |
| CA — REDDING | $228 | $343 — $571 |
| CA — REST OF CALIFORNIA | $228 | $343 — $571 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $235 | $353 — $588 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $235 | $353 — $588 |
| CA — SALINAS | $234 | $351 — $585 |
| CA — SAN DIEGO-CHULA VISTA-CARLSBAD | $236 | $354 — $591 |
| CA — SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) | $257 | $385 — $642 |
| CA — SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) | $260 | $389 — $649 |
How to Reduce Your Cost for Critical care, first 30-74 minutes
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($320) differs from the facility rate ($223). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Medicare rates for this procedure range from $188 to $299 depending on location. Commercial rates vary even more.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU () x CF ($33.40) = N/A
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Critical care, first 30-74 minutes cost?
The Medicare facility rate for Critical care, first 30-74 minutes is $223. In a hospital outpatient setting, the rate is $844. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Critical care, first 30-74 minutes cost without insurance?
Without insurance, the cost of Critical care, first 30-74 minutes can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Critical care, first 30-74 minutes?
Most commercial health insurance plans and Medicare cover Critical care, first 30-74 minutes when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.