Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month
Medicare pricing data for 3,325 providers across 48 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month (HCPCS code 99426) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $59.85, but hospitals typically charge $144.96 — a 2.4x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $59.85, your out-of-pocket cost would be approximately $11.97. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 2.4x more than what Medicare allows for this procedure. Medicare actually pays $46.61 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New Jersey | $65 | $173 | 114 | 6,277 | +8.6% |
| California | $64 | $152 | 176 | 21,922 | +7.7% |
| Massachusetts | $64 | $141 | 11 | 41 | +7.0% |
| Maryland | $64 | $109 | 134 | 9,397 | +6.3% |
| Hawaii | $64 | $88 | 5 | 264 | +6.2% |
| New York | $63 | $164 | 287 | 31,436 | +4.9% |
| Connecticut | $62 | $173 | 5 | 4,537 | +3.4% |
| District of Columbia | $62 | $133 | 6 | 447 | +3.2% |
| Rhode Island | $62 | $178 | 3 | 49 | +3.1% |
| Colorado | $61 | $144 | 160 | 3,795 | +1.8% |
| Florida | $61 | $174 | 142 | 12,252 | +1.3% |
| Wyoming | $60 | $220 | 7 | 468 | +0.7% |
| Delaware | $60 | $94 | 19 | 1,280 | +0.2% |
| Alaska | $60 | $306 | 1 | 22 | -0.1% |
| North Dakota | $60 | $60 | 2 | 282 | -0.3% |
| Michigan | $60 | $122 | 126 | 1,521 | -0.4% |
| Montana | $59 | $130 | 10 | 666 | -0.9% |
| Washington | $59 | $175 | 46 | 534 | -1.1% |
| Illinois | $59 | $124 | 173 | 8,578 | -1.2% |
| Virginia | $59 | $128 | 82 | 4,462 | -1.8% |
| Texas | $59 | $127 | 315 | 31,902 | -1.8% |
| North Carolina | $58 | $137 | 90 | 2,156 | -2.3% |
| Arizona | $58 | $148 | 101 | 2,719 | -2.4% |
| Minnesota | $58 | $167 | 57 | 1,759 | -2.6% |
| Nevada | $58 | $180 | 75 | 679 | -2.7% |
| Louisiana | $58 | $135 | 92 | 8,061 | -3.2% |
| South Carolina | $58 | $79 | 41 | 10,299 | -3.2% |
| Puerto Rico | $58 | $118 | 2 | 86 | -3.2% |
| Utah | $58 | $175 | 35 | 4,602 | -3.3% |
| Pennsylvania | $58 | $202 | 64 | 4,671 | -3.4% |
| Ohio | $58 | $178 | 118 | 8,448 | -3.5% |
| Oregon | $57 | $152 | 31 | 466 | -4.4% |
| Oklahoma | $57 | $132 | 26 | 2,991 | -4.4% |
| Wisconsin | $57 | $181 | 14 | 383 | -4.5% |
| Kansas | $57 | $113 | 23 | 249 | -4.7% |
| Kentucky | $57 | $88 | 39 | 2,668 | -5.3% |
| Alabama | $57 | $82 | 37 | 189 | -5.5% |
| Tennessee | $56 | $133 | 193 | 6,950 | -5.9% |
| New Mexico | $56 | $148 | 9 | 600 | -5.9% |
| Nebraska | $56 | $120 | 24 | 583 | -6.0% |
| Mississippi | $56 | $109 | 36 | 5,209 | -6.2% |
| Indiana | $56 | $184 | 90 | 6,731 | -6.8% |
| Arkansas | $55 | $146 | 27 | 3,430 | -7.7% |
| Missouri | $55 | $132 | 89 | 2,730 | -8.0% |
| Iowa | $55 | $183 | 25 | 2,030 | -8.7% |
| Idaho | $54 | $143 | 22 | 842 | -9.5% |
| Georgia | $54 | $175 | 102 | 2,338 | -10.3% |
| West Virginia | $50 | $101 | 12 | 200 | -16.7% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber