How Much Does an ER Visit Cost? A Data Analysis of 285 U.S. Hospitals

National ER Visit Facility-Fee Cash Prices by Acuity Level

ER visits are billed by acuity level — how sick you are and how many resources the hospital uses. Level 3 (99283) is a moderate visit, Level 4 (99284) is higher, and Level 5 (99285) is the highest-acuity non-critical visit. The hospital, not you, assigns the level. These are cash-pay facility fees only; click a level to compare every hospital's posted price side by side.

Cash-pay facility fees filtered to a $100–$50,000 plausibility window; 8 hospitals posted sub-$100 values that appear to be copay fragments or deposits rather than a facility fee. These figures cover the facility charge for the visit only — the ER physician, labs, imaging, and any procedures are billed separately and are not included.

The Transparency Paradox

The federal Hospital Price Transparency Rule took effect in 2021 to make hospital prices comparable. Five years on, the same emergency-room billing code — 99285, a Level 5 visit — carries a facility fee of just $108 at McLaren Bay Region in Bay City, Michigan and $17,730 at Sky Ridge Medical Center in Lone Tree, Colorado. That is a 164x gap for the identical code, published publicly by both hospitals under the same rule.

We call this the Transparency Paradox: the data is now public, but it didn't narrow what hospitals charge — and for the ER it barely had a chance to, because no patient is comparison-shopping facility fees mid-emergency. The disclosure requirement assumed a functioning market. The emergency room is the part of health care least able to behave like one, which is why the spread here is wider than for almost any shoppable procedure we track. The number is on the hospital's website; whether you ever see it before the bill arrives is another matter entirely.

Why ER Visit Cost Varies So Much

• The acuity level the hospital codes. The biggest single driver. A visit coded Level 3 (99283) carries a median facility fee around $412; Level 4 (99284) around $640; Level 5 (99285) around $958 — and the Level 5 range runs all the way to $17,730. The hospital assigns the level based on the resources it says the visit consumed, and coding practices vary widely between facilities.
• The facility fee itself. This is the charge just for being seen, before any treatment — the largest and most opaque piece of the bill. It exists to cover the cost of keeping a 24/7 emergency department staffed and open, and hospitals set it with no federal ceiling.
• Freestanding ER vs. hospital emergency department. Free-standing emergency rooms can look and feel like an urgent-care clinic but bill full ER facility fees. Two buildings on the same street — one an urgent care, one a freestanding ER — can differ by thousands of dollars for what feels like the same visit.
• Facility type, ownership, and geography. Large for-profit hospital systems and dense metro markets post the highest facility fees; rural and community hospitals post the lowest. The most expensive facilities in our data are metro for-profit hospitals concentrated in a handful of high-cost markets.
• Everything else is billed on top. The ER physician's professional fee is a separate bill, often from a separate physician group that may be out of network. Every lab, every CT scan, X-ray, or ultrasound, every medication and procedure adds its own line item. The facility fee is where the bill starts, not where it ends.

The 10 Most Expensive and 10 Cheapest ER Facility Fees

Posted cash facility fees for a Level 5 ER visit (CPT 99285), one row per hospital (lowest posted cash price each). Click any hospital to see its full price and compare cash vs. gross vs. insurance-negotiated rates. Remember: these are the facility charges only — the doctor, labs, and imaging are extra.

10 Most Expensive (CPT 99285)

10 Cheapest (CPT 99285)

A patient at Sky Ridge Medical Center in Lone Tree, CO faces a Level 5 facility fee of $17,730 — 164x the $108 facility fee at McLaren Bay Region in Bay City, MI. Both hospitals publish these prices publicly under the same federal rule, and both figures are the facility charge only, before the physician, labs, and imaging.

How to Pay Less for Emergency Care

First, the only rule that matters: if you are having a real emergency — chest pain, trouble breathing, signs of a stroke, severe bleeding, a head injury — call 911 or go to the ER. Do not let cost delay emergency care. Everything below is for non-emergencies, and for managing the bill afterward.

1. For non-emergencies, consider urgent care or telehealth instead. A sprain, a minor cut, a fever, or a UTI handled at an urgent-care clinic or by a telehealth visit avoids the ER facility fee entirely — often a difference of hundreds to thousands of dollars for the same complaint.
2. Confirm whether a facility is an ER or an urgent care. Freestanding emergency rooms often look like clinics but bill full ER facility fees. Before you walk in for something non-urgent, ask directly: "Is this an urgent care or an emergency room?" The signage and the bill don't always match your expectation.
3. Ask for an itemized bill and the facility-fee level. When the bill arrives, request a fully itemized statement. Find the ER visit code (99283, 99284, or 99285) and the level the hospital assigned — that single line is usually the largest charge.
4. Review the coded level. Hospitals sometimes code a visit at a higher acuity level than the care delivered. If you were seen quickly for a minor issue but were billed a Level 5 (99285), ask the hospital to justify the level and to review it.
5. For a non-emergency, get a good-faith estimate. If you're self-pay and the visit is scheduled or non-urgent, you're entitled to a written good-faith estimate of the cost before care under the No Surprises Act.
6. Apply for financial assistance. Nonprofit hospitals are required to offer charity-care and financial-assistance programs, and most hospitals will reduce a self-pay ER balance substantially if you ask and apply.

What to Ask About Your ER Bill

• What acuity level was my ER visit coded — 99283, 99284, or 99285 — and why?
• Can I get a fully itemized bill showing the facility fee separately from everything else?
• Is the ER physician's bill separate from the hospital's, and was that doctor in my network?
• Which charges are for labs, imaging (CT, X-ray, ultrasound), and procedures, versus the facility fee?
• If I'm self-pay, do you offer a prompt-pay discount or a financial-assistance application?
• Was this a hospital emergency department or a freestanding ER, and were the in-network rates applied?
• Under the No Surprises Act, was I protected from out-of-network balance billing for this emergency visit?

Frequently Asked Questions

References & Further Reading

• CMS Hospital Price Transparency Rule (45 CFR 180) — the federal requirement that produces the underlying data on this page.
• CMS: No Surprises Act — Protections for Emergency Services — how the law shields you from out-of-network balance billing for emergency care.
• CMS: No Surprises Act — Good-Faith Estimates — your right to a written cost estimate before a scheduled, non-emergency service.
• American College of Emergency Physicians: Emergency Medicine 101 — guidance on when emergency care is warranted versus urgent care.

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