Urgent Care vs ER Visit Cost: Medicare's 2026 Price in Every State

Moderate emergency room visit, Medicare 2026

$5441

Doctor $117Hospital $426Urgent care $181

Medicare's 2026 approved amount for a moderate emergency room visit is about $544 before a single test is run. That is the emergency doctor's fee ($117.34 in the middle of Medicare's 107 fee areas1) plus the hospital's facility fee ($426.302).

The same moderate problem seen at a freestanding urgent care center is about $181 for a new patient, because an urgent care center is paid like a doctor's office: one fee, no hospital facility fee1. That gap, about $363 a visit, is the whole story of urgent care vs the ER.

What you actually pay

On Original Medicare, an urgent care visit costs you 20% of the Medicare-approved amount once you have met the Part B deductible4. That deductible is $283 for 20265.

The emergency room stacks two bills. You pay a copayment for the ER visit and for each hospital service you get, and after the deductible, 20% of the approved amount for the doctor3. The hospital file lists the 20% copayment for every visit level: $55.78 for a low-level visit, $85.26 for moderate and $121.69 for high2. If the hospital admits you for the same problem within 3 days, Medicare folds the ER visit into the inpatient stay and you don't pay the ER copayments3.

With private insurance, the ER bill usually arrives the same two ways, a doctor's fee and a hospital fee, so check your plan's ER copay before you need it. If you are out of network in an emergency, the No Surprises Act protects you from a surprise out-of-network ER bill6.

Price your own visit

Pick your Medicare fee area, where you go and how serious it is. The doctor's fee is this year's rate for your area1. The hospital fee is CMS's national rate2; Medicare raises or lowers part of it for local wages, so in a high-cost city it runs a little above this.

Our math on CMS's 2026 files. X-rays, lab work, stitches, scans and drugs are billed on top. A Medigap or Medicare Advantage plan can change your share.

A worked example: Riverside County, California

Riverside and San Bernardino counties are one Medicare fee area. Say a 70-year-old on Original Medicare wakes up with a bad cough and a fever, has no Part B bills yet this year, and needs a doctor to decide whether it is pneumonia. That is a moderate visit at either door.

Already met the deductible? Then the bill is $37.13 at urgent care against $109.18 at the ER, and the chest X-ray the doctor orders comes on top at either place. Same cough, same decision, $360 more for Medicare and more for the patient just for walking through the hospital's door.

When the ER is the right door

The price gap only matters when urgent care can handle the problem. Medicare defines an emergency department visit as care for an injury, a sudden illness, or an illness that quickly gets much worse3, and urgently needed care as a sudden illness or injury that isn't a medical emergency or life threatening4. Chest pain, trouble breathing, signs of a stroke, a head injury or heavy bleeding go to the ER, whatever it costs. An urgent care center will send those cases to the ER anyway, and then you pay for both visits.

The five ER levels

An ER bill is coded by how complex the doctor's decision was, from level 1 to level 5. Each level has a doctor's fee1 and a hospital fee2. Total approved amount in the middle fee area, 2026:

1. Level 199281$97.10
2. Level 299282$197.02
3. Level 399283$347.86
4. Level 499284$543.64
5. Level 599285$778.62

Critical care, the code for the first hour of treating a life-threatening condition, pays the hospital $843.922 and the doctor $198.15 in the middle fee area1. If your bill shows level 4 or 5 for something you were in and out for, ask the hospital for the itemized bill and how the level was picked.

Hospital-run urgent care and part-time ERs

Not every urgent care is freestanding. When an urgent care clinic is run as a hospital outpatient department, the hospital can bill its own clinic visit fee on top of the doctor ($136.02, code G04632), and Medicare says you then also owe a copayment4. Before you go, ask whether the clinic bills as part of a hospital.

Some hospital emergency departments are not open 24 hours a day. Medicare calls them Type B departments and pays them less per visit: $419.62 for the hospital at the highest level against $608.43 at a full-time ER2.

Where the ER doctor's fee is highest and lowest

Medicare adjusts the doctor's fee for local rent, wages and malpractice cost. For a moderate ER visit, the highest-paid fee areas are:

1. Alaska$159.73
2. NYC Suburbs/Long IslandNew York$136.96
3. MiamiFlorida$136.73
4. ChicagoIllinois$134.09
5. ManhattanNew York$133.38
6. QueensNew York$132.00
7. San Jose-Sunnyvale-Santa Clara (San Benito County)California$129.53
8. East St. LouisIllinois$128.89

Lowest:

1. Wisconsin$109.52
2. Nebraska$109.81
3. Iowa$109.91
4. Arkansas$110.45
5. Minnesota$110.45
6. South Dakota$110.48
7. Idaho$110.88
8. Kansas$111.00

Emergency doctor's fee only, CPT 99284, 20261. The national base rate before any local adjustment is $118.24.

Urgent care and ER visit rates, every state

CMS 2026 rates12. Where a state has more than one Medicare fee area, you see the low and high. “Urgent care, low” is a new-patient visit of low complexity (99203). The ER columns are the doctor's fee plus the hospital's fee for a low (99283), moderate (99284) and high (99285) visit.

Puerto Rico and the Virgin Islands have their own fee areas and are left out. The Hawaii fee area also covers Guam. Hospital fees are CMS's national rates.

How we got these numbers

We took the relative value units for each visit code from CMS's October 2026 physician fee schedule file and multiplied them by the geographic cost indexes for each of the 107 Medicare fee areas in the 50 states and DC, then by the 2026 conversion factor of $33.40091. ER doctors are paid at the facility rate; urgent care visits use the office (non-facility) rate, which is how a freestanding urgent care center is paid. Hospital fees are CMS's October 2026 national rates for hospital outpatient visits2. “Middle” means the median across fee areas, not weighted by population. Nothing here is a price a hospital has quoted; it is what Medicare approves, and what most cash and commercial prices are measured against.