How much does a level 4 (high severity) emergency room visit cost in the US?

Across 1,224 hospitals that publish federally required price files, the median negotiated rate is $495, and the middle half of hospitals fall between $400 and $800. Self-pay cash prices have a median of $783 across the 997 hospitals that list one. What you pay out of pocket depends on your deductible, coinsurance and network.

Why do ER Visit (Level 4) prices vary so much?

Each hospital negotiates separately with each insurer. In these files the priciest tenth of hospitals negotiated more than 5.8 times what the cheapest tenth did, and state medians run from $375 in Alabama to $2,166 in Utah.

Is the cash price cheaper than using insurance?

Sometimes. At 331 of the 997 hospitals that list a cash price (33%), it is lower than that hospital's own median negotiated rate. If you have a high deductible, ask the hospital for its self-pay price before you book.

What is the Medicare rate shown here?

$426 is the CMS national outpatient (OPPS) payment rate for this service (July 2026). We show it as a government baseline: the national median negotiated rate is 1.2 times it.

All procedures / ER Visit (Level 4)

ER Visit (Level 4) Cost in the US (2026): What 1,224 Hospitals NegotiatedNPI VERIFIED

Across 1,224 US hospitals that publish federally required price files, the median negotiated rate for a level 4 (high severity) emergency room visit is $495 — 1.2× the Medicare outpatient rate of $426. The middle half of hospitals negotiated between $400 and $800; the priciest tenth negotiated more than $1,426, 5.8× the cheapest tenth (under $247). Hospitals that list a self-pay price ask a median of $783 (997 hospitals).

Code CPT 99284 · Source: hospital machine-readable files (45 CFR §180), file dates 2022-11-12 to 2026-09-28 (median 2026-04-01) · Medicare baseline: CMS OPPS Addendum B, July 2026 · Data extracted 2026-10-06 · Page updated 2026-10-07

National median

$495

all plan types · 1,224 hospitals

Middle half

$400–$800

25th–75th percentile of hospitals

Median cash price

$783

self-pay · 997 hospitals list one

Medicare baseline

$426

CMS OPPS national · July 2026

1,224 hospitals, one bar per price band

median $495Medicare $426

$0$1,000$2,000

Each bar counts hospitals whose median rate falls in that price band; the last, dashed bar holds the 58 at $2,000 or more. The cheapest tenth negotiated under $247, the priciest tenth over $1,426 — 5.8× apart for the same procedure.

These are contract reference rates, not your bill. A median across hospitals is not a quote for your plan or network. Your out-of-pocket cost depends on your deductible, coinsurance and network status.

This is the hospital's facility fee for the visit level only. Tests, imaging, medication and the emergency physician's own fee are billed separately.

Coverage: 1,224 of the 5,419 hospitals in the CMS roster have an identity-verified price file with this procedure in our data. It is not a random sample, and a hospital missing here has not been judged non-compliant — we may simply not have its file yet. 96 of these 1,224 hospital files were more than 12 months old at extraction — hospitals must update yearly; we keep the figures and say so rather than hide them.

By insurance type

Insurance type	Hospitals	Median	Middle half	× Medicare
Commercial (plan type not stated)	702	$929	$580 – $1,558	2.2×
PPO	730	$1,113	$674 – $1,760	2.6×
HMO	494	$962	$592 – $1,596	2.3×
EPO	115	$1,135	$725 – $2,279	2.7×
POS	65	$1,261	$951 – $2,494	3.0×
ACA Marketplace	454	$716	$547 – $967	1.7×
Medicare Advantage	732	$415	$340 – $465	1.0×
Medicare (as listed)	689	$426	$390 – $478	1.0×
Medicaid	746	$379	$194 – $585	0.9×
Federal employees (FEP)	22	$2,280	$1,920 – $2,365	5.3×
Workers' comp	129	$778	$449 – $1,206	1.8×

Plan types are grouped from each hospital's plan names. Each figure is a median of hospital-level medians; types with fewer than 20 hospitals are left out.

By state

State	Hospitals	Median	Middle half	× Medicare	Median cash
Alabama	17	$375	$361 – $385	0.9×	$359
Arizona	12	$457	$438 – $479	1.1×	$1,182
Arkansas	15	$396	$335 – $456	0.9×	$820
California	40	$565	$534 – $652	1.3×	$1,471
Colorado	8	$476	$422 – $662	1.1×	$901
Florida	50	$463	$459 – $929	1.1×	$1,306
Georgia	31	$478	$419 – $743	1.1×	$604
Hawaii	9	$877	$421 – $1,643	2.1×	$1,577
Idaho	14	$650	$359 – $1,303	1.5×	$940
Illinois	48	$610	$447 – $966	1.4×	$879
Indiana	25	$464	$439 – $1,493	1.1×	$1,011
Iowa	49	$424	$277 – $548	1.0×	$568
Kansas	52	$556	$357 – $754	1.3×	$626
Kentucky	50	$608	$424 – $928	1.4×	$1,125
Louisiana	29	$399	$360 – $517	0.9×	$526
Maine	9	$413	$364 – $775	1.0×	$459
Maryland	9	$558	$504 – $607	1.3×	$566
Massachusetts	9	$603	$516 – $725	1.4×	$1,091
Michigan	30	$437	$121 – $510	1.0×	$263
Minnesota	31	$612	$431 – $812	1.4×	$868
Mississippi	21	$375	$297 – $391	0.9×	$500
Missouri	31	$410	$387 – $436	1.0×	$669
Montana	20	$478	$337 – $892	1.1×	$711
Nebraska	32	$427	$339 – $568	1.0×	$640
Nevada	9	$1,419	$878 – $1,419	3.3×	$1,760
New Hampshire	5	$536	$505 – $3,779	1.3×	$2,963
New Jersey	22	$1,156	$617 – $1,929	2.7×	$653
New Mexico	11	$435	$411 – $522	1.0×	$615
New York	38	$521	$463 – $555	1.2×	$603
North Carolina	22	$460	$411 – $963	1.1×	$1,143
North Dakota	11	$426	$358 – $561	1.0×	$528
Ohio	51	$433	$395 – $722	1.0×	$1,055
Oklahoma	38	$413	$352 – $613	1.0×	$470
Oregon	24	$613	$515 – $939	1.4×	$1,600
Pennsylvania	60	$449	$416 – $722	1.1×	$1,066
Rhode Island	5	$754	$500 – $779	1.8×	$799
South Carolina	27	$417	$406 – $565	1.0×	$1,260
South Dakota	12	$1,009	$749 – $1,189	2.4×	$1,154
Tennessee	22	$410	$404 – $437	1.0×	$310
Texas	102	$578	$413 – $1,163	1.4×	$830
Utah	21	$2,166	$827 – $2,417	5.1×	$2,074
Vermont	9	$447	$421 – $652	1.0×	$738
Virginia	19	$427	$427 – $1,245	1.0×	$762
Washington	20	$547	$421 – $751	1.3×	$955
West Virginia	9	$602	$367 – $737	1.4×	$844
Wisconsin	26	$484	$379 – $847	1.1×	$636
Wyoming	10	$825	$534 – $960	1.9×	$970

middle half of hospitalsstate medianMedicare rate · a dotted end means the range runs past $2,000

States with at least 5 hospitals in our data (47 states). 4 smaller states are counted in the national figures but not listed — a median of two or three hospitals says more about those hospitals than about the state.

Get the data

Hospital-level and insurer-level rates for this procedure are in the full dataset. A free three-procedure sample (brain MRI, head CT, diagnostic colonoscopy) is open under CC BY 4.0: DOI 10.5281/zenodo.23199844 · Kaggle.

Frequently asked questions

How much does a level 4 (high severity) emergency room visit cost in the US?: Across 1,224 hospitals that publish federally required price files, the median negotiated rate is $495, and the middle half of hospitals fall between $400 and $800. Self-pay cash prices have a median of $783 across the 997 hospitals that list one. What you pay out of pocket depends on your deductible, coinsurance and network.
Why do ER Visit (Level 4) prices vary so much?: Each hospital negotiates separately with each insurer. In these files the priciest tenth of hospitals negotiated more than 5.8 times what the cheapest tenth did, and state medians run from $375 in Alabama to $2,166 in Utah.
Is the cash price cheaper than using insurance?: Sometimes. At 331 of the 997 hospitals that list a cash price (33%), it is lower than that hospital's own median negotiated rate. If you have a high deductible, ask the hospital for its self-pay price before you book.
What is the Medicare rate shown here?: $426 is the CMS national outpatient (OPPS) payment rate for this service (July 2026). We show it as a government baseline: the national median negotiated rate is 1.2 times it.

Other emergency room prices

ER Visit (Level 3)

median $307 · 1,220 hospitals

ER Visit (Level 5)

median $712 · 1,223 hospitals

See all 30 procedures →