average cost of emergency room visit 2022 without insurance

How much does an ER visit cost?

$1,500 – $3,000 average cost without insurance (non-life-threatening condition), $0 – $500 average cost with insurance (after meeting deductible).

Average ER visit cost

An ER visit costs $1,500 to $3,000 on average without insurance, with most people spending about $2,100 for an urgent, non-life-threatening health issue. The cost of an emergency room visit depends on the severity of the condition and the tests, treatments, and medications needed to treat it.

Cost data is from research and project costs reported by BetterCare members.

Emergency room visit cost with insurance

The cost of an ER visit for an insured patient varies according to the insurance plan and the nature and severity of their condition. Some plans cover a percentage of the total cost once you meet your deductible, while others charge an average co-pay of $50 to $500 .

The No Surprises Act , effective January 1, 2022, protects insured individuals from unreasonably high medical bills for emergency services received from out-of-network providers at in-network facilities. The act also established a dispute resolution process for both insured and uninsured or self-pay individuals.

Cost of an ER visit without insurance

An ER visit costs $1,500 to $3,000 on average without insurance for non-life-threatening conditions. Costs can reach $20,000+ for critical conditions requiring extensive testing or emergency surgery. Essentially, the more severe your condition or issue, the more you are likely to pay for the ER visit.

Factors that impact ER visit costs

Many factors affect the cost of an ER visit, including:

Facility type – Freestanding emergency departments often cost 50% more than hospital-based emergency rooms.

Time of day – An ER visit at night typically costs more than the same type of visit during the day.

Level of care – The more severe your condition is, the more time and expertise it takes to diagnose and treat, and the higher the total ER visit cost.

Ambulance ride – An ambulance ride costs $500 to $1,300 on average, depending on whether you need basic or advanced life support during transport.

Medications – Oral medications, injections, or IVs needed during your stay all add the total cost of your ER visit.

Medical equipment & supplies – Any other supplies used to diagnose and treat you—such as a cast for a broken bone or bandages and sutures to close an open wound—increase the cost.

Testing – Each medical test is typically a separate charge. Tests may include urine tests, blood tests, X-rays, or other more advanced imaging tests.

Insurance coverage:

Out-of-pocket costs may be higher for those with high-deductible insurance plans.

While ER visit costs are generally higher for the uninsured, many hospitals offer discounts for self-pay patients.

ER facility fee by level

An ER facility fee ranges from $200 to $4,000 , depending on the severity level of your symptoms and condition. The facility fee is the cost to walk in the door and be evaluated by a physician. Other services you may need, such as lab tests, imaging, and surgical procedures, are charged separately.

To understand your ER bill: Emergency rooms rank severity levels 1 through 5, with Level 1 being the most severe or urgent. However, most of the billing codes for emergency room visits are reversed, with level 1 being the least severe.

Common conditions and procedures

The table below shows the average ER visit cost for common ailments. Prices vary greatly depending on how much testing and expertise is required to accurately diagnose and treat you.

Emergency room vs. urgent care

An ER visit costs $1,500 to $3,000 , while the average urgent care visit costs $150 to $250 without insurance. Urgent care facilities can treat most non-life-threatening conditions and typically have less wait time than the ER. For more detail, check out our guide comparing the cost of an emergency room vs. urgent care .

Other alternatives to the ER for less serious health issues include primary care, telemedicine, and free clinics. Check with the National Association of Free and Charitable Clinics to find a free clinic near you.

FAQs about ER visit costs

Why are er visits so expensive.

ER visits are expensive because emergency rooms run on a 24-hour schedule and require a large and wide range of staff, including front desk personnel, maintenance, nurses, doctors, and surgeons. ERs also run and maintain a lot of expensive equipment and need a constant supply of medications and medical supplies.

While ER visits can be expensive, ER bills are negotiable. If you receive an unexpectedly large ER bill, ask for a discount and question the coding.

Does insurance cover ER visits?

Insurance typically covers some or all of an ER visit, though you may need to meet a deductible first, depending on the plan. The Affordable Care Act requires insurance providers to cover ER visits for "emergency medical conditions" without prior authorization and regardless of whether they are in or out-of-network.

An "emergency medical condition" is considered something so severe that a reasonable person would seek help right away to avoid serious harm.

When should you go to the ER?

You should go to the ER for any serious, potentially life-threatening symptoms, including:

Trouble breathing

Serious head injury

Sudden severe pain

Severe burn

Severe allergic reaction

Major broken bones

Uncontrollable bleeding

Suddenly feeling weak or unable to move, speak, or walk

Sudden change in vision

Sudden confusion

Fever that does not resolve with over-the-counter medicine

Tips to reduce your ER bill

An ER visit can cost thousands of dollars, even if you have insurance. Here are some guidelines to ensure you are not overpaying:

Determine if you truly need an emergency room. If your health issue is not life threatening, consider going to an urgent care facility instead as the cost for the same care can be much less.

Go to a hospital-based ER. Freestanding ER centers typically cost much more than a hospital-based emergency room.

Call ahead to confirm payment options and the current wait time.

Ask about costs up front. If you are uninsured, consider asking the following questions to prevent you from surprises on your future bill:

Do you have discounted pricing for patients without insurance?

Will it cost less if I pay with cash?

What will the fee be for my specific issue?

Do you think I will need additional tests, and what will they cost?

How much do you charge for X-rays?

If I need medication, how much will it cost?

Using our proprietary cost database, in-depth research, and collaboration with industry experts, we deliver accurate, up-to-date pricing and insights you can trust, every time.

How Much Does an ER Visit Cost? Free Local Cost Calculator 

It’s true that you can’t plan for a medical emergency, but that doesn’t mean you have to be surprised when it’s time to pay your hospital bill. In 2021, the U.S. government enacted price transparency rules for hospitals in order to demystify health care costs. That means it should be easier to get answers to questions like how much an ER visit costs.

While the question seems pretty straightforward, the answer is more complicated. Your cost will vary based on factors such as if you’re insured, whether you’ve met your deductible, the type of plan you have, and what your plan covers. 

There is a lot to consider. This guide will take you through specific scenarios and answer questions about insurance plans, deductibles, co-payments, and discuss scenarios such as how much it costs if you go to the ER when it isn’t an emergency. 

You’ll learn a few industry secrets too. Did you know that if you don’t have insurance you might see a higher bill? According to the Wall Street Journal , it’s common for hospitals to charge uninsured and self-pay patients higher rates than insured patients for the same services. So, where can you go if you can’t afford to go to the ER?

Keep reading for all this plus real-life examples and cost-saving tips.

How Much Does an ER Visit Cost Without Insurance?

Everything is more expensive in the ER. According to UnitedHealth, a trip to the emergency department can cost 12 times more than a typical doctor’s office visit. The average ER visit is $2,200, and doesn’t include procedures or medications. 

If you want to get a better idea of what an ER visit will cost in your area, check out our medical price comparison tool that analyzes data from thousands of hospitals.

Compare Procedure Costs Near You

Other out-of-pocket expenses you may incur include bills from third parties. A growing number of emergency departments in the United States have become business entities separate from the hospital. So, third-party providers may bill you too, like:

• EMS services, like an ambulance or helicopter 
• ER physicians
• Attending physician
• Consulting physicians
• Advanced practice nurses (CRNA, NP)
• Physician assistants (PA)
• Physical therapists (PT)

And if your insurance company fails to pay, you may have to pay these expenses out-of-pocket.

How Much Does an ER Visit Cost With Insurance? 

The easiest way to estimate out-of-pocket expenses for an ER visit (or any other health care service) is to read your insurance policy. You’ll want to look for information around these terms:

• Deductible: The amount you have to pay out-of-pocket before your insurance kicks in . 
• Copay: A set fee you pay upfront before a covered medical service or procedure. 
• Coinsurance: The percentage you pay for a service or a procedure once you’ve met the deductible.
• Out-of-pocket maximum: The most you will pay for covered services in a rolling year. Once met, your insurance company will pay 100% of covered expenses for the rest of the year. 

Closely related to out-of-pocket expenses like deductibles and co-insurance are premiums. A premium is the monthly fee you (or your sponsor) pay to the insurance company for coverage. If you pay a higher premium, you’ll have a lower deductible and fewer out-of-pocket costs whenever you use your insurance to pay for services such as a visit to the ER. The opposite is also true — high deductible health plans (HDHP) offer lower monthly payments but much higher deductibles. 

Sample ER Visit Cost

Using a few examples from plans available on the Marketplace on Healthcare.gov (current as of November 2021), here’s how this might play out in real life:

Rob is a young, healthy, single guy. He knows he needs health insurance but he feels reasonably sure that the only time he’d ever use it is in case of an emergency. Here’s the plan he chooses:

Plan: Blue Cross/Blue Shield Bronze Monthly premium: $394 Deductible: $7,000 Out-of-pocket maximum: $7,000 ER coverage: 100% after meeting the deductible

Rob does the math and considers the worst case scenario. If he does go to the ER, he’ll pay full price if he hasn’t yet met his deductible. But since both his deductible and his maximum out-of-pocket are the same, $7,000 is the most he’ll have to pay before his insurance kicks in at 100%.

Now imagine that Rob gets married and is about to start a family. He might need a different insurance plan to account for more hospital bills, doctors appointments, and inevitable emergency room visits.

Since Rob knows he’ll be using his insurance more often, he picks a plan with a lower deductible that covers more things. 

Plan: Bright HealthCare Gold Monthly premium: $643 Deductible: $0 Out-of-pocket maximum: $6,500 ER coverage: $500 Vision: $0 Generic prescription: $0 Primary care: $0 Specialist: $40

This time Rob goes with a zero deductible plan with a higher monthly premium. It’s more out-of-pocket each month, but since his plan covers doctor’s visits, prescription drugs, and vision, he feels more prepared as his lifestyle shifts into family mode. 

If he has to go to the ER for any reason, all he’ll pay is $500 and his insurance pays the rest. And worse case scenario, the most he’ll pay out-of-pocket in a year is $6,500. 

How Much Does an ER Visit Cost if You Have Medicare?

Medicare Part A only covers an emergency room visit if you’re admitted to the hospital. Medicare Part B covers 100% of most ER costs for most injuries, or if you become suddenly ill. Unlike private insurance and insurance purchased on the Affordable Care Act (ACA) Marketplace, Medicare rarely covers ER visits that happen while you’re outside of the United States.

To learn more, read: How to Use the Healthcare Marketplace to Buy Insurance

How Much Does an ER Visit Cost for Non-Emergencies?

When you have a sick child but lack insurance, haven’t met your deductible, or if you’re between paychecks, just knowing you can go to the ER without being hassled for money feels like such a relief. ER staff won’t demand payment upfront, and they usually don’t ask about insurance or assess your ability to pay until after discharge.

There are other reasons, too. You might be tempted to go to the ER for situations that are less than emergent because emergency departments provide easy access to health services 24/7, including holidays and the odd hours when your primary care physician isn’t available. If you’re one of the 61 million Americans who are uninsured or underinsured , you might go to the ER because you don’t know where else to go.

What you may not understand is the cost of an ER visit without insurance can total thousands of dollars. Consumers with ER bills that get sent to collections face some of the most aggressive debt collection practices of any industry. Collection accounts and charge-offs could affect your credit score for the better part of a decade.

Did you know that charges begin racking up as soon as you give the clerk your name and Social Security number? There are tons of horror stories out there about people receiving medical bills after waiting, some for many hours, and leaving without treatment. 

4 ER Alternatives Ranked by Level of Care

First and foremost, if you’re experiencing a medical emergency, call 911 or go to the closest emergency room. Do not rely on this or any other website for advice or communication. 

If you’re not sure whether your condition warrants immediate, high-level emergency care, you can always call your local ER and ask to speak to their triage nurse. They can quickly assess how urgent the situation is. 

If you are looking for a lower-cost alternative to the ER, this list provides a few options. Each option is ranked by their ability to provide you with a certain level of care from emergent care to the lowest level, which is similar to the routine care you would receive at a doctor’s office. 

1. Charitable Hospitals  

There are around 1,400 charity hospitals , clinics, and pharmacies dedicated to serving low-income families, including the uninsured. Most charitable, not-for-profit medical centers provide emergency room services, making it a good option if you’re uninsured and worried about accruing substantial medical debt. 

ERs at charitable hospitals provide the same type of medical care for conditions like trauma, broken bones, and life-threatening issues like chest pain and difficulty breathing. The major difference is the price tag. Emergency room fees at a charity hospital are usually flexible and almost always based on your income. 

2. Urgent Care Centers

Urgent care centers are free-standing facilities designed to treat patients with serious but not life-threatening conditions. Also called “doc in a box,” these ambulatory care centers are a good choice for treating stable but chronic health issues, fever, urinary tract infections, back pain, abdominal pain, and moderately high blood pressure, to name a few. 

Urgent care clinics usually have a medical doctor on-site. Some clinics offer point-of-care diagnostic tests like ultrasound and X-rays, as well as basic lab work. The average cost for an urgent care visit is around $180, according to UnitedHealth.

3. Retail Health Clinics

You may have noticed small retail health clinics (RHC) popping up in national drugstore chains like CVS, Walgreens, and in big-box stores like Target and Walmart. The Little Clinic is an example of an RHC that offers walk-in health care services at 190 supermarkets across the United States. 

RHCs help low-acuity patients with minor medical problems like sore throat, cough, flu-like symptoms, and other conditions normally treated in a doctor’s office. If you think you’ll need lab tests or other procedures, an RHC may not be the best choice. Data from UnitedHealth puts the average cost for an RHC visit at $100.

4. Telehealth Visits

Telehealth, in some form, has been around for decades. Until recently, it was mostly used to provide access to care for patients living in the most remote or rural areas. Since 2020, telehealth visits over the phone, via chat, or through videoconferencing have become a legitimate and extremely cost-effective alternative to in-person office visits. 

Telehealth is perfect for some types of mental health therapies, follow-up appointments, and triage. For self-pay, a telehealth visit only costs around $50, according to UnitedHealth.

Tips for Taking Control of Your Health Care

• Don’t procrastinate. Delaying the care you need for too long will end up costing you more in the end. 
• Switch your focus from reactive care to proactive care. Figuring out how to pay for an ER visit is a lot harder (and costlier) than preventing an ER visit in the first place. Data show that preventive health care measures lead to fewer illnesses and better outcomes.
• Plan for the unknown. It’s inevitable that at some point in your life you’ll need health care. Start a savings account fund or better yet, enroll in a health savings account (HSA). If you’re employed (even part-time) you already qualify for an HSA. A contribution of just $9 a paycheck could add up to $468 tax-free dollars for you to spend on health care every year. Unlike the use-it-or-lose-it savings plans of the past, modern plans don’t expire. You can use HSA dollars to pay for out-of-pocket costs like copayments, deductibles, and for services that your health insurance may not cover, like dental and vision services. 
• Advocate for yourself. There is nothing more empowering than taking charge of your health. Shop around for services and compare prices on procedures to make sure you’re getting the best prices possible.
• If you are uninsured or doing self-pay, negotiate your bill and ask for a cash discount. 

Estimate the Cost of the ER Before You Need It

It’s stressful to think about money when you’re facing an emergency. Research the costs of your nearest ER before you actually need to go with Compare.com’s procedure cost comparison tool . 

All you have to do is enter your ZIP code and you’ll immediately see out-of-pocket costs for ER visits at your local emergency rooms. It works for other medical services too, like MRIs, routine screenings, outpatient procedures, and more. Find the treatment you need at a price you can afford.

Disclaimer: Compare.com does not offer medical advice and is in no way a substitute for any medical advice received from health professionals. Compare.com is unable to offer any advice on any medical procedure you may need.

Nick Versaw leads Compare.com's editorial department, where he and his team specialize in crafting helpful, easy-to-understand content about car insurance and other related topics. With nearly a decade of experience writing and editing insurance and personal finance articles, his work has helped readers discover substantial savings on necessary expenses, including insurance, transportation, health care, and more.

As an award-winning writer, Nick has seen his work published in countless renowned publications, such as the Washington Post, Los Angeles Times, and U.S. News & World Report. He graduated with Latin honors from Virginia Commonwealth University, where he earned his Bachelor's Degree in Digital Journalism.

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Emergency department visits exceed affordability threshold for many consumers with private insurance

By Hope Schwartz Twitter ,  Matthew Rae Twitter ,  Gary Claxton ,  Dustin Cotliar,  Krutika Amin , and  Cynthia Cox Twitter

December 16, 2022

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Introduction

The high cost of emergency care may impact patients’ ability to afford treatment , with almost half of US adults reporting they have delayed care due to costs. Almost 1 in 10 Americans have medical debt , and about half of American households do not have the liquid assets to afford an average employer sponsored plan deductible. More than one third of US adults are unable to afford a $400 medical expense without borrowing.

Costs of medical emergencies present an additional financial burden on top of already costly health insurance premiums ranging $1,327 for single coverage and $6,106 for family coverage, on average, for workers with employer sponsored insurance. Variation in emergency department billing may make it difficult to predict the cost of an emergency department visit and subsequent financial liability. Recently, the No Surprises Act legislation aimed to curb unexpected emergency medical costs by prohibiting out-of-network billing for emergency services.

In this analysis, we use 2019 insurance claims data from the Merative MarketScan Commercial Database, which captures privately insured individuals with large employer health plans. We look at the total and out-of-pocket costs of emergency department visits for this group, overall and by diagnosis and severity level. We also look at which services contribute most to the costs of emergency department visits and examine regional variation in emergency department costs. Finally, we look at the demographic profile of consumers who visited the emergency department and the relationship between emergency department spending and annual spending for enrollees.

We find that enrollees spend $646 out-of-pocket, on average, for an emergency department visit. Enrollees with high annual health spending were more likely to visit the emergency department; the majority of enrollees in the top 10% of annual health care spending had at least one emergency department visit during the year. The most expensive components of most emergency department visits include evaluation and management charges, imaging, and laboratory studies, and facility fees make up 80% of the cost of visits. Cost varies by disease, visit complexity, and geographic region.

Large employer plan enrollees’ emergency department visits cost $2,453, on average, with enrollees responsible for $646 in out-of-pocket costs

On average, enrollees in large employer health plans who have an emergency department visit spend $646 out-of-pocket on the visit. There is significant variation in emergency department spending, with 25% of visits costing over $907 out-of-pocket and another quarter costing less than $128 out-of-pocket. These out-of-pocket costs for a single emergency department visit may be more than some people with private insurance can afford and, in some cases, could entirely deplete a consumer’s savings. For example, about 1-in-5 people (21%) with private insurance living in single-person households have less than $1,000 in liquid assets.

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How financially vulnerable are people with medical debt?

These amounts only include out-of-pocket spending required by the insurer. Before the No Surprises Act went into effect in January 2022, privately insured patients who visited the emergency department frequently had out-of-network claims on their visit, putting them at risk of providers sending them surprise balance bills. The No Surprises Act now prohibits most surprise out-of-network billing, but does not apply to ground ambulances . Any balance bill that a patient received from a provider would not appear in claims data and therefore would have been in addition to the out-of-pocket amounts shown here.

In total, enrollees and insurers paid $2,453, on average, per visit, with one quarter of visits costing $970 or less and another quarter costing $3,043 or more. All the costs described in this analysis are for the emergency department visits only, including professional services and facility fees, and do not include any spending on subsequent hospitalizations.

Facility fees contribute significantly more than professional fees to total visit cost

Emergency department bills are categorized as facility fees or professional fees. Professional fees are for services provided by clinicians, and facility fees include bills for services rendered using equipment owned by the facility, including laboratory or imaging studies. These fees are considered “overhead” for emergency departments and help facilities maintain appropriate staffing levels and technical resources. Evaluation and management charges also have a facility fee component for the equipment, staffing, and administrative resources used by the physician in their management. We find that facility fees make up 80% of total visit cost.

Evaluation and management charges make up the largest share of costs

Including both the professional fee and facility fee components of charges, the largest contributor to spending on a typical emergency department visit is the evaluation and management charge, which accounts for almost half (44%) of average visit costs. Evaluation and management charges are bills for the assessment of a patient that are not related to specific procedures or treatments provided; these services cost over $1,100 per visit, on average.

Imaging charges, including radiologist interpretation fees, make up an additional 19% of the average emergency department visit charge and cost $483, on average. The highest cost routinely performed imaging services include x-rays of the chest and CT scans of the head, chest, abdomen, and pelvis. Over half of visits (55%) include a charge for imaging services. About half of patients (49%) are charged for laboratory studies, including blood tests, which cost $230 on average. Other high cost but less common charges include surgical charges for patients with appendicitis and other conditions requiring surgery without inpatient admission, as well as ambulance charges for transport.

Heart attacks and appendicitis among the most expensive common conditions treated in the emergency department

Costs of emergency department visits depend on diagnosis. We selected nine common reasons to visit the emergency department that vary in complexity of management. More severe conditions, or those with more intervention required, are the most expensive. Of the nine specific diagnoses that we evaluated, the lower-cost diagnoses were those that generally do not require imaging or extensive treatment in the emergency department. These included upper respiratory tract infections ($1,535 total, $523 out-of-pocket), skin and soft tissue infections ($2,005 total, $572 out-of-pocket), and urinary tract infections ($2,726 total, $683 out-of-pocket). While these diagnoses can occasionally require admission to the hospital, in otherwise healthy adults they are typically evaluated with basic laboratory studies and discharged with prescriptions.

The most expensive emergency department diagnosis among those we examined is appendicitis, which, on average, costs $9,535 ($1,717 out-of-pocket) per visit. Appendicitis is almost two times as expensive as the next most expensive diagnosis we looked at, heart attack. 11% of enrollees with a diagnosis of appendicitis had surgical charges associated with their emergency department visit. Surgical costs may be included in emergency department outpatient billing because these patients are often discharged after surgery without being admitted to the hospital. In contrast, other emergency department visits requiring surgery are often admitted to the hospital and have surgical charges during their inpatient visit. Enrollees who had surgery had more expensive visits by over $2,000 compared to those who did not; however even without surgery, visits for appendicitis were almost four times as expensive as the average emergency department visit (and more than twice as expensive out-of-pocket).

Enrollees with emergency department visits have variable annual spending depending on diagnosis

In addition to the costs of the emergency department visit itself, enrollees who visit the emergency department at least once during the year have higher annual health care spending. Annual spending includes the cost of all claims for each patient in 2019, either before or after their emergency department visit. Though appendicitis was the most expensive emergency department visit among the diagnoses we analyzed, enrollees with appendicitis in 2019 incurred an average of $24,333 in additional health care spending, which was comparable to lower cost diagnoses. Enrollees with heart attacks had at least two times more annual spending than any other diagnosis ($52,993), while enrollees with upper respiratory tract infections had the lowest annual spending ($13,727).

These differences in annual costs may reflect spending both directly related and unrelated to the emergency department visit. For example, enrollees with heart attack emergency department visits may have high annual spending because of follow-up, medications, or hospitalizations after their heart attacks. However, their high annual spending may also reflect more comorbidities and higher healthcare utilization at baseline. In contrast, appendicitis, the most expensive emergency department visit, is correlated with relatively lower annual costs; unlike heart attacks, appendicitis often occurs in younger, healthier people and requires comparatively little additional post-surgical follow-up or treatment.

The most complex emergency visits are more than 6 times as expensive as the least expensive visits, but insurers pay an increasing share of the visit as complexity increases

Emergency department visits are coded by complexity during the billing process, from 1 (least complex) to 5 (most complex). Each evaluation and management charge is associated with a procedure code ranging from level 1 to level 5 (99281 to 99285), which are generated by hospital coding professionals based on the physicians’ medical note. Criteria are defined by the Centers for Medicare and Medicaid Services ( CMS ) and based on the complexity of documentation and medical decision making. Patients with level 1 complexity codes require straightforward medical decision making, with self-limited or minor presenting problems, such as rashes or medication refills. Patients with level 5 codes require high complexity medical decision making and present with life- or limb-threatening conditions, such as severe infections or cardiac arrests.

The lowest complexity visits cost $592 on average, with enrollees responsible for $205, or about one-third of the total visit cost. As visits increase in complexity, both out-of-pocket costs and costs covered by insurance increase. For the highest complexity visits, the health plan covers $3,015 on average, or eight times the cost of the lowest complexity visits. On average, patients pay $840 out-of-pocket for the highest complexity visits, which is four times their out-of-pocket costs for the lowest complexity visits.

Higher complexity visits are more expensive for multiple reasons. In general, evaluation and management charges are higher cost for more complex patients. Also, patients with more complex medical conditions generally receive more diagnostic tests, medication, and other treatment, which increases the cost of the visit. For the lowest complexity visits, evaluation and management charges account for almost half (47%) of the overall visit cost. In contrast, evaluation and management charges for the highest complexity visits account for about one-fourth (27%) of the total visit cost, with additional services including tests and treatment making up a larger share of the cost.

Emergency department costs vary by geographic region

We analyzed the top 20 metropolitan statistical areas (MSAs) by population, where data are available. Overall, the San Diego, CA area had the most expensive average ED visits ($3,761 on average). San Diego ED visits were more than twice as expensive as Baltimore, MD, the least expensive MSA in our analysis ($1,645 on average). Expensive MSAs were geographically distributed in all regions of the country including the South, West, Northeast, and Midwest. Within each MSA, there was significant variation in visit costa. For example, 25% of visits in Oakland, CA cost less than $1,236 on average, while 25% cost more than $4,436 on average.

Some variation may be based on the distribution of diagnoses in each area, with more serious or complex diagnoses leading to higher cost visits. For example, if a metro area sees higher than average volume of appendicitis, heart attacks, or other high-cost diagnoses, that would drive up regional emergency department costs.

For common diagnoses, Texas and Florida MSAs are among the most expensive

If we examine costs for specific diagnoses, we can minimize some of this variation in reasons for visits and gain a better understanding of how prices and service intensity affect the rankings. We selected two common, moderate-cost reasons for emergency department visits: low back pain and lower respiratory infections. While these visits can range in complexity and treatment required, they usually do not require hospital admission or high-cost treatment. Low back pain includes patients who present with the symptom of low back pain, regardless of diagnosis. Lower respiratory tract infection includes infectious causes of pneumonia and bronchitis. This analysis was limited to MSAs in which there were >500 cases of each diagnosis in 2019.

Visit costs for both diagnoses in Dallas, TX, Houston, TX, Fort Worth, TX, and Orlando, FL are in the top five most expensive MSAs with >500 cases. For low back pain visits, the Orlando, FL, Fort Worth, TX, Dallas, TX, and Houston, TX areas are each more than twice as expensive as the Warren, MI and Detroit, MI areas, on average. This trend is similar for lower respiratory tract infections. Within MSAs, variation in costs exist for both diagnoses. For example, for low back pain visits, there is more than a $3,000 difference between the least expensive and most expensive quarter of visits in Fort Worth, TX, Dallas, TX, and Houston, TX.

12% of large employer group enrollees went to the emergency department in 2019

We find that 12% of large group enrollees under age 65 had at least one emergency department visit in 2019, and of enrollees with emergency department visits, 80% had only one visit. 20% had more than one visit, and 7% had more than two visits. Emergency department visits were associated with higher annual health care spending, with almost half of enrollees in the top 25% of annual spending having at least one emergency department visit during the year.

We find that the average emergency department visit exceeds the threshold that some consumers can pay without borrowing, and even one emergency department visit in a year may create financial hardship for enrollees in large employer plans. For example, one quarter of emergency department visits for large employer enrollees cost over $907 out-of-pocket. Meanwhile, about 1-in-5 people with private insurance do not have $1,000 in liquid assets, and almost half of US adults report that they would not be able to pay a $500 medical bill without going into debt. Emergency department visits range significantly in cost depending on diagnosis, visit complexity, and geographic area. These variations may present challenges for consumers trying to predict the cost of their emergency department visit prior to going to the emergency department.

Several factors contribute to the variability of emergency department charges. First, unlike other forms of outpatient care including primary care or urgent care visits, emergency departments charge facility fees to offset the cost of keeping emergency departments open and staffed 24/7. These fees vary widely and are increasing at a faster rate than overall health care spending. The facility component represented 80% of total emergency department spending in our analysis. Many hospitals and health care providers consider these costs necessary given their mandate to provide emergency triage and treatment to allcomers. A second contributor to variation is that services are often billed at different complexity levels, and visits that are billed as more complex are more expensive . In some cases, even similar services are billed at different prices by different facilities. Notably, surprise out-of-network medical bills from emergency departments have contributed to high emergency costs for consumers, though the cost of any balance bills would be outside the scope of our claims data. The implementation of the No Surprises Act in January 2022 will generally curb surprise medical billing for emergency care.

As seen in non-emergency spending , we find that emergency department costs vary by geographic area. Among the most expensive MSAs in our analysis were MSAs located in Texas, Florida, California, Colorado, and New York. Interestingly, the most expensive regions for ED care do not align with the most expensive regions for overall health care spending. These comparisons suggest that our findings are not solely related to overall high health care prices in these areas and may reflect other factors including the age and medical complexity of the population or differences in local norms and practice patterns. State-level emergency department regulation may also play a role—states with higher numbers of freestanding , non-hospital affiliated emergency departments (which are associated with higher spending on emergency care) were among the most costly in our analysis.

The financial implications of visiting the emergency department vary widely. Not all the variation in total charges is reflected in out-of-pocket costs, since differences in cost by complexity level are smaller after insurance covers its portion of the bill. However, the most complex emergency department visits have four times higher out-of-pocket costs than the least complex visits. Even the least complex visits, some of which could be treated by a primary care office or urgent care center, cost an average of $205 out-of-pocket ($592 total). Given facility fees and relatively high evaluation and management charges in emergency departments, insurers and patients are paying more when receiving care for these conditions at emergency departments than they would using primary or urgent care. These lower complexity visits may represent a substantial avoidable cost to patients and the health care system at large.   

High health care costs are of foremost concern for US adults, leading people to skip recommended medical treatment or delay necessary care. Even in the era of new price transparency regulation , which aims to improve consumer access to prices for elective care, emergency department consumers often do not know what testing or treatment they will need, so it is difficult to assess the costs of a visit upfront. Further, in an emergency situation, patients may not be able to choose their provider or facility if they are brought in by ambulance or otherwise unable to direct their care. Lastly, lack of availability and standardization in data may make it difficult for patients to use price transparency data in real time to make decisions about accepting tests and treatment in an emergency. The high and variable cost of emergency department visits represents an opportunity for future policy changes to protect consumers from unaffordable medical bills.

This analysis is based on data from the Merative MarketScan Commercial Database, which contains claims information provided by a sample of large employer plans. Enrollees in MarketScan claims data were included if they were enrolled for 12 months. This analysis used claims for almost 14 million people representing about 17% of the 85 million people in large group market plans (employers with a thousand or more workers) from 2004-2019. To make MarketScan data representative of large group plans, weights were applied to match counts in the Current Population Survey for enrollees at firms of a thousand or more workers by sex, age, state, and whether the enrollee was a policy holder or dependent.

Emergency department visits were flagged if an enrollee had an emergency department evaluation and management claim in the emergency department or the hospital on a given day. If an enrollee had either an emergency evaluation and management claim or another claim originating in the emergency department on the day prior to or after the flagged day, we added the previous and or following day’s outpatient spending to the visit cost. This was to capture all emergency department services for visits that may have spanned overnight or multiple days. Over half (53%) of the spending in this analysis occurred in the emergency department, with another 42% occurring in the hospital, which may occur when a patient receives a test or procedure in a location outside the emergency department during their visit.

Claims were included if they were above $100 and below the 99.5 th percentile of cost. Selected conditions were generated from a literature review of common emergency department diagnoses and defined using ICD10 codes. Enrollees were considered to have a certain diagnosis if the relevant ICD10 code appeared in the “Diagnosis 1” column in one or more claims on an emergency department visit day. While emergency department claims have up to four diagnoses, diagnoses listed in 2-4 were not used to identify relevant conditions because these diagnoses were most often incidentally found rather than related to the reason for presenting to the emergency department. For specific diagnosis definitions: Heart attack includes acute STEMI and NSTEMI, and excludes complications from prior heart attacks or angina; UTI includes acute cystitis, UTI and pyelonephritis; Kidney stone includes renal calculus in any location and renal colic; Lower respiratory infection includes pneumonia and bronchitis. Surgical charges for acute appendicitis include both open and laparoscopic surgical charges. Annual spending was defined as the total spending for each enrollee in the year 2019, which could occur before and/or after their emergency department visit depending on the time of year of the emergency department visit.

This analysis has some limitations. First, there is a chance that we could incorrectly include non-emergency outpatient care (such as a next-day, follow up primary care appointment) in our estimate of emergency department visit costs. Secondly, when accounting for annual spending, we do not control for health status prior to the emergency department visit. Therefore, the increase in annual health spending for patients who visit the emergency department for certain conditions may be because these patients are sicker and higher healthcare utilizers at baseline, rather than specific follow-up costs incurred for the emergency department visit itself. For selecting relevant diagnoses, we only include claims in which a particular diagnosis occurs as the primary diagnosis. Third, the MarketScan database includes only charges incurred under the enrollees’ plan and do not include balance billing to enrollees which may have occurred. Lastly, our findings only represent enrollees in large group employer sponsored plans and may not be generalizable to other groups.

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Home   ›   Blog   ›   How Much Does an ER Visit Cost Without Insurance In 2022

How Much Does an ER Visit Cost Without Insurance In 2022

Published January 30th, 2023 by Timothy McGuire

General Posts

Any accident may occur, and people may feel severe health problems. There is the loudness of the ambulance from here and there. Then they are taken to the emergency room (ER) for treatment. Most people may opt for an emergency room as a better place to seek immediate recovery from any health problem. An ER visit is not just for accidental injury but for feeling severe health complications anyhow. In the same way, ER provides emergency services that are available there. There are skilled and dedicated doctors, nurses, and modern technology to make sure severe illnesses of the people can be prevented.

So the cost factor is one of the significant issues as ER visits are much higher than any other medical service. So it is important to know about such ER visits and also one should know how much does an ER visit costs without insurance in 2022. Here we are going to discuss a lot of issues on this topic to make sure you can know how ER visit works, the cost of an ER visit, and how you can limit the cost of an ER visit without insurance.

Emergency Department

When people get sick and ill, they are found to take treatment either at home or in the hospital. But the severity of the sickness and illness may be so high. When it goes high and people stay at home, there is the possibility of facing any danger in life. Then they might seek emergency hospitalization.

Emergency Department or Emergency room (ER in brief) is a department of the hospital and medical center where there is medical treatment on an emergency basis. Surely people may have different conditions of illness. It is just from low to severe. When there are life-risking factors and the family members think it is very crucial, they may think of the emergency department or emergency room. In this case, the patients and the people on behalf of the patients don’t have to take prior appointments. In most cases, people may be unsure about medical needs and don’t wait for a doctor’s appointment. These includes

• Broken bones
• Head and Neck injury
• Serious burns
• Stroke Symptoms
• Uncontrolled vomiting
• Vomiting with blood

How ER Visit Works

Surely emergency room is one of the most equipped and advanced rooms where people go for emergency treatment. In most cases, people may have a serious condition of heart, chest pain, head and neck injury, or serious burn. In this case, they don’t have any way to go for first aid treatment but feel the need to visit an emergency room. They rush on foot but it is common to see the loudness of the ambulance on the road as they are going to the emergency room.

Then the department or emergency room ensures initial treatment even it is a broad spectrum of illness and injuries as it is unplanned and unsure. When it comes to life-threatening, they go to immediate action in consultation with the higher consultants. But if it is seen that the patients are going to be well after taking initial treatment from the emergency room, they are not admitted to the hospital.

This type of department or room is open for 24 hours in hospitals and medical centers. There is fully equipped staff in the emergency room and they provide treatment according to the condition of the patients. But it may be seen that there is a long time waiting due to the number of emergency cases.

Now it comes to the cost and expense of the emergency room. Surely, many people may be surprised to see the higher cost of visiting an emergency room even if it is a minor case. The emergency room may be costly due to several reasons such as emergency standby doctors, higher quality of using medical supplies such as aspirin, bandages and these are provided there. There is also part of insurance and people may seek to reduce the cost by the part of the law and the cost may be so higher for the people who don’t have insurance.

Why Choose Emergency Room vs Urgent Care

When it comes to emergency treatment and medication, people seek immediate medical attention in the hospital. In this case, the emergency room is the most common issue and place to choose from. But there is another option which is urgent care. It is just about making a decision about which one can fit the best for the people who are in a bad situation.

There are still a lot of issues to know about emergency rooms and urgent care. Urgent care is a center that ensures primary care physician and emergency room services. When you need no appointment for the emergency room, you don’t need it in this care. But there is no major difference between emergency care and urgent care. Urgent care may not be available for 24 hours and some urgent care center closes at 9.00 pm or later. But the emergency care is open 24 hours and 365 days a year.

The most important issue to consider is that you need to visit the emergency room when you have life-threatening conditions like injuries and symptoms. On the other hand, it is only possible to get services when there is a non-life-threatening situation. Under urgent care, one may opt for minor cuts, back pain, minor burns, and so on. More importantly, the cost at urgent care center is less compared to an emergency room visit.

What Are The Cost Factors of ER

Surely the cost of the emergency room is much more and people may see it as horrific after getting emergency care. But it is important to distinguish between the emergency room and a normal hospital. Surely the services at the emergency room may not be possible to get at a normal hospital. On the other hand, people want to get an immediate solution to their illness and symptoms. So many people don’t even think of the cost factor. But it is also important to know why the cost of ER goes up.

The cost of an ambulance transportation

When people have a severe health problem, they call an ambulance equipped with life-saving medical equipment. It is common to see such an ambulance rushing to the patient’s home and getting them in the emergency room. For this, the transportation of the patient adds up more cost.

Emergency room costs

An emergency room is equipped with tools and instruments to make sure you can treat trauma. There are MRIs and Surgeries and high-quality supplies which are costly to treat the emergency patient for quick recovery. If you face an accident and you get trauma, it is possible to get to the emergency room, and it adds up the cost significantly. It is also important to note that the emergency room is open for 24 hours with trained and skilled staff, making the costs so high. More importantly, the emergency room needs to have uninterrupted electricity, water, food, and supplies along with medical care.

• How Much Does An ER Visit Cost Without Insurance In 2022

When people get the bills after taking treatment from the emergency room, they fall from the sky. But it is important to know these costs as before so that there is a plan to reduce the cost. The ER cost may be higher compared to regular hospital bills. It is also important to note that the cost of the treatment may go higher than the fixed rate for the room when the treatment goes extensive. It can’t be said that there is a fixed cost of the emergency room but this visit may cost less than $2200. But there are different types of costs according to the type of treatment. But these costs come without insurance plans.

• Chest pain may cost by $1000
• Broken Bones with surgery may cost by $10000
• Stitches for an accident may cost by $500
• There are also some costs of the common conditions where these are treated in the ER visit and these includes
• Acute Bronchitis may cost by $814
• Sore Throat may cost $620
• Low back pain may cost by $751
• Attention to dressing or removal of sutures may cost $343

It is also important to note that this cost is not fixed for all medical centers and hospitals. There may be changes from low to higher and higher to low in different hospitals. Additionally, the cost may also be different in different states.

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Average ER Visit Cost By State

The cost of an ER visit is a big issue for people who are low-income and it is important to know such cost before. Even if there is no insurance coverage, the cost goes higher and it may be sky-high for the people. This cost is also not static due to more advanced forms of treatment in the emergency room. According to a study and research, the ER cost in 2019 was found on average by $1220 without insurance. But this cost has gone up by $2200 and it may even be more by reaching $20,000 for extensive and critical care. 

The cost of ER visits without insurance discussed above is just average and this can vary according to different states. So we are going to discuss the average cost of all states without insurance. 

• Florida:  The average cost of ER visit comes by $3102 without insurance coverage. 
• New Jersey:  The average cost of ER without insurance in this state is $3087.
• California : The average cost of ER visit without insurance in this state is $2960.
• Colorado: The average cost of ER visit without insurance in this state is $2886.
• Nevada : The average cost of ER visit without insurance in this state is $2583.
• Texas : The average cost of ER visit without insurance in this state is $2318.
• Arizona: The average cost of ER visit without insurance in this state is $2283.
• Idaho: The average cost of ER visit without insurance in this state is $2159.
• Hawaii: The average cost of ER visit without insurance in this state is $2076.
• Alaska : The average cost of ER visit without insurance in this state is $2070.
• Virginia : The average cost of ER without insurance in this state is $1941.
• Tennessee: The average cost of ER visit without insurance in this state is $1883.
• Washington D.C : The average cost of ER visit without insurance in this state is $1879.
• Nebraska : The average cost of ER visit without insurance in this state is $1844.
• Washington : The average cost of ER visit without insurance in this state is $1841.
• Illinois: The average cost of ER visit without insurance in this state is $1818.
• New Hampshire : The average cost of ER visit without insurance in this state is $1787.
• South Carolina : The average cost of ER visit without insurance in this state is $1758.
• Rhode Island : The average cost of ER without insurance in this state is $1750.
• Kentucky : The average cost of ER visit without insurance in this state is $1740.
• Missouri: The average cost of ER visit without insurance in this state is $1717.
• New York : The average cost of ER visit without insurance in this state is $1668.
• Pennsylvania : The average cost of ER visit without insurance in this state is $1645.
• South Dakota: The average cost of ER visit without insurance in this state is $1641. 
• Indiana : The average cost of ER visit without insurance in this state is $1618.
• Delaware : The average cost of ER visit without insurance in this state is $1596.
• Georgia : The average cost of ER visit without insurance in this state is $1596.
• North Carolina : The average cost of ER visit without insurance in this state is $1589.
• Mississippi: The average cost of ER visit without insurance in this state is $1583.
• New Mexico : The average cost of ER visit without insurance in this state is $1574.
• Alabama : The average cost of ER visit without insurance in this state is $1496.
• Wisconsin: The average cost of ER visit without insurance in this state is $1496.
• Connecticut: The average cost of ER visit without insurance in this state is $1493.
• Oklahoma: The average cost of ER visit without insurance in this state is $1466.
• Utah: The average cost of ER visit without insurance in this state is $1464.
• Minnesota: The average cost of ER visit without insurance in this state is $1462.
• Oregon : The average cost of ER visit without insurance in this state is $1437.
• Ohio : The average cost of ER visit without insurance in this state is $1435.
• Wyoming : The average cost of ER visit without insurance in this state is $1411.
• Vermont : The average cost of ER visit without insurance in this state is $1386.
• Iowa:  The average cost of ER visit without insurance in this state is $1377.
• Arkansas : The average cost of ER visit without insurance in this state is $1304.
• Kansas: The average cost of ER visit without insurance in this state is $1294.
• Michigan : The average cost of ER visit without insurance in this state is $1273.
• North Dakota : The average cost of ER visit without insurance in this state is $1245.
• Massachusetts : The average cost of ER visit without insurance in this state is $1200.
• Louisiana : The average cost of ER visit without insurance in this state is $1184.
• Montana : The average cost of ER visit without insurance in this state is $1138.
• West Virginia : The average cost of ER visit without insurance in this state is $1127.
• Maine: The average cost of ER visit without insurance in this state is $952.
• Maryland : The average cost of ER visit without insurance in this state is $623.

What Happens If Insurance Coverage 

ER visits may cost from $150 to $3000 in different situations and locations. Surely it is too much expensive for so many people. When you are visiting this ER, there is still available treatment for the patient. It is important to make sure this care is not cheap. So insurance is part of a law to make ER visits affordable. There may be health insurance plans with a lower monthly premium that you may go. This can help you get a cap of around $250 on emergency room expenses. In the insurance policy, there may be guidelines on coverage in terms of an ER visit. But it generally covers the most basic ER visits. More importantly, you should check your coverage where it is available based on in-Networks ERs.

How is the Cost Determined in the ER Visit by Level?

The illness, injuries, and symptoms may have different stages and this stage determines the emergency treatment process in the ER room. This stage is medically known as level and there are generally five levels from 1 to 5. This is important to know these levels for everyone who even didn’t go to the emergency room. The level is also explained as the emergency severity index scale or intensity of the illness of the people. 

• Level 1: Level 1 means life-threatening issues and it may be more extensive and critical treatment and care by the emergency room. The typical cost of such event may stand by $1450. 
• Level 2: Level 2 is not just like Level 1 but it is a severe problem that seeks urgent medical attention and evaluation. This cost may come by $870 on average. 
• Level 3: level 3 is not just about level 2 in which risk is a little bit low but treatment may be a good option in this case. Additionally, there is a chance of developing risk when treatment is not taken. The typical cost of such a level is $650. 
• Level 4: Level 4 is not just about Level 3 but people with illness in this level have less chance of death. But this type of level can’t be ignored for better health. The cost maybe $400. 
• Level 5:   People have very limited and minor problems and the average cost of this illness may be $150. 

How Can I Lower The Cost Of ER Visits

As said, ER cost is higher and it has legit ways to be high. Some low-income people may find it at a reduced rate. For there are some ways that can work to limit the higher cost of the ER visit. This includes

1. Discuss with hospital charitable programs 

Surely every hospital is not for money-making and they also provide treatment for the poor people even it is higher. These hospitals do have ER but also have CSR policies. They have also a social responsibility to provide low-cost health care for low-income people. For this, you may discuss such charitable programs and get significant discounts on your bills.

2. See primary care physician 

When some get injured and server symptoms, they should not opt for ER for the first time. They may seek primary care physicians that can be cheap and affordable in case it is not life-threatening issues. In this case, urgent care may be a good option indeed.

3. Try Telemedicine 

Now that Telemedicine is one of the good ways to get treatment. It is a system to get treatment at home over the phone. The doctors over there are skilled and experts to hear your problem and provide solutions to your physical problem.

4. Seek free clinic 

Surely there are so many free clinics and a low-cost hospital where there is also an emergency room. These free clinics charge less for low-income people. Everyone should know about these free clinics and hospitals before to make sure they can go there in their emergencies.

5. Do it right now 

When we are healthy, we don’t think of our health for a single moment. But it is not right indeed. A smile health problem may be severe and one may go through a bad situation when they see the sky-high bill amount. For this, there are so many government programs like Medicaid, Medicare, CHIP that they can enroll in and get affordable health care.

6. Be prepared 

When there is a serious moment, we don’t remember anything close to us that is low cost and cheap. Surely you may identify your root health problem and decide what to do. In case there is a serious health problem, you can go to an ER visit. If it is minor problem, you can go to urgent care at a lower cost. On the other hand, you should know before where there are low-cost offers and programs for ER visits near your location. This can be a good deal indeed to go for saving your money as well.

Frequently Asked Questions

So there are some questions to answer and most people seek these answers as information. So we have covered such answers to make sure you can know more.

What happens in ER visit?

An ER visit is an emergency visit that is meant as a serious health problem. When you go to an ER visit, A triage nurse normally who is the staff there will assess the condition. You may need to wait there according to their examination process and they may tell you to go to an exam room. Some doctors will review your test results and provide instructions for the next steps.

What is a Level 4 ER visit?

Level 4 is the parameter to assess the condition of the health problem. Surely there are different types of injuries and symptoms of the health. These are categorized into different levels. So Level 4 is a type of problem that explains it is so severe. In this case, urgent evaluation is mandatory to treat the complication.

How much does an ER visit cost in Florida?

Florida is one of the most expensive states in the United States of America. In the same way, ER visit cost in Florida is a little bit high. But it is found that moderate to severe ER patients have to count a bill of on average $3102. This can be lower or higher according to a different location in Florida.

Final Verdict

Health is wealth and we need to ensure it. But there is nothing to do as an accident may occur in the blink of our eyes. Then people with injury or other health symptoms may need to go to an ER visit. There are so many hospitals and clinics in every location that provide emergency care in the Emergency room. You need to study and research this emergency room and visit the cost according to your location. Surely this can be helpful when you know much before facing a bad situation.

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Why An ER Visit Can Cost So Much — Even For Those With Health Insurance

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The Costs of US Emergency Department Visits

The US population made 144.8 million emergency department (ED) visits in 2017, costing a total of $76.3 billion, estimated a recent statistical brief from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP).

That year, 13.3% of the US population incurred an expense for an ED visit, and more than half of hospital inpatient stays originated with an ED visit. More than half of 2017 ED costs for the entire US, $39.5 billion, were incurred in large metropolitan areas. Aggregate ED visit costs and share of ED visit volume were highest for hospitals in the South. (ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on Centers for Medicare & Medicaid Services hospital accounting reports.)

Read More About

Rubin R. The Costs of US Emergency Department Visits. JAMA. 2021;325(4):333. doi:10.1001/jama.2020.26936

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How Much Does an Emergency Room Visit Cost Without Insurance?

An emergency room (ER) visit can be extremely expensive, especially if you do not have health insurance. Understanding the potential costs is important to avoid financial shock when you receive the medical bills.

This article will provide an overview of typical ER costs, factors that influence pricing, and ways to manage expenses for uninsured patients. Having the right information can help you make wise choices when a health emergency strikes.

The emergency room provides urgent care for injuries and sudden illnesses. However, treatment does not come cheap. Charges are generally much higher than doctor office or urgent care visits. For uninsured patients, an ER visit often leads to massive medical debt due to the high prices.

Emergency room costs vary widely depending on the hospital, location, and services provided. Uninsured patients typically face out-of-pocket charges between $150-$3,000 or more per visit. Here are some typical price ranges:

• Minor treatment like stitches or basic X-rays: $150-$700  – Simple procedures or tests usually cost less, but prices still add up quickly without insurance.
• Moderate treatment like sprains/fractures or CT scans: $700-$1,500  – More complex issues require more resources, driving up charges for the uninsured.
• Major treatment like surgery or hospital admission: $1,500+  – Serious conditions often rack up thousands in medical bills for ER treatment and inpatient care.

According to SmartFinancial , a visit to the emergency room can cost up to  $2,200 without insurance , with the average cost in 2021 being $1,150 .

GoodRx notes that on average, emergency room visits cost anywhere from $2,400 to $2,600 without insurance .

Debt.org writes that uninsured patients making emergency department visits in 2019 had an average cost of $1,749 , with the average expense for people aged 45-64 being $2,285 .

According to Mira , the costs for an individual without insurance range anywhere from $80 to $280 for a basic Level I urgent care visit and $140 to $440 for an urgent care visit involving imaging services such as X-rays or ultrasounds.

Keep in mind, that these ranges are just estimates. Actual charges depend on many factors discussed later. Always expect higher prices without insurance, sometimes exponentially higher.

Emergency Room Visits Overview

It helps to understand what constitutes an ER visit when considering potential costs. In general, the emergency room handles urgent medical issues like:

• Accidents and trauma leading to wounds or broken bones
• Sudden, severe pain or pressure (headaches, chest pain, etc.)
• Major burns or electrical shocks
• Seizures, dizziness, or loss of consciousness
• Difficulty breathing or shortness of breath
• Severe bleeding or hemorrhage
• Poisoning or drug overdose
• Complications of pregnancy like bleeding or preterm labor

Anything potentially life-threatening requires emergency care. For less serious matters, an urgent care clinic or doctor’s office may suffice for lower costs.

Cost Factors for ER Visits Without Insurance

Many elements impact the charges for uninsured ER visits, including:

• Services rendered  – More extensive treatment, testing, and procedures quickly increase costs. Simple visits are cheapest.
• Staff involved  – Doctors, nurses, technicians, and specialists cost more per hour. More personnel equals higher bills.
• Diagnostics/equipment used  – X-rays, CT scans, MRIs, and labs carry high price tags, often thousands per test.
• Medications provided  – Emergency drugs, injections, IV fluids/medications are all very expensive.
• Facility/hospital fees  – Overhead like equipment, utilities, and administration all drive up prices.
• Emergency room type  – Trauma centers and hospital-based ERs often cost more than standalone ERs.
• Inpatient admission  – If you require hospitalization, additional facility and bed fees apply, which uninsured patients must cover.

Without insurance to negotiate lower prices, ERs bill at full rates. Charges add up very quickly in a crisis scenario.

Comparing ER Costs to Other Medical Services

To put ER expenses in context, compare costs to other healthcare settings without insurance:

• Primary doctor visit  – $75-$200 for minor illness or injury.
• Urgent care visit  – $100-$350 for issues needing quick attention.
• Retail clinic visit  – $40-$125 for basic concerns like flu, rashes, or cuts.

As you can see, the ER costs up to 10x more than other medical facilities for people not under an insurance plan. Prices may even exceed $1,000 for serious emergency issues. Always weigh options carefully before going to the expensive ER.

Financial Assistance and Payment Options

Uninsured patients have some options to reduce or defer medical bills from an ER visit:

• Payment plans  – Most hospitals offer interest-free monthly payments, often lasting 6-12 months.
• Discounts  – Ask if the hospital provides any prompt-pay or self-pay discounts. These offer 20-30% off medical bills.
• Charity care  – Based on income, hospitals may forgive part or all of an uninsured patient’s ER charges.
• Government aid  – Medicaid may provide retroactive coverage if you qualify after an ER visit.
• Crowdfunding  – Using GoFundMe and similar websites to ask for public donations is an option.
• Medical credit cards – Special credit cards help finance medical ER bills over time for qualifying applicants.
• Hospital legal aid – Many facilities offer assistance in disputing excessive charges or obtaining aid.

Talk to hospital billing representatives about these potential options after an ER visit. Uninsured patients have rights and avenues to alleviate costs.

You might also like our articles about the cost of endoscopy , antibiotics , or emergency dentists without insurance.

The Impact of Location and Hospital Type

• State and region – Overall healthcare expenses are lower in rural and Southern states versus coastal, and urban areas.
• Public, charity, or private hospital  – Government and nonprofit hospitals offer more financial assistance and discounted care.
• Hospital size/level of care – Major medical care centers and teaching hospitals are the most expensive.
• Independent vs. hospital-based ER  – Freestanding ERs tend to have lower facility fees.
• In-network vs. out-of-network  – Insurers negotiate lower in-network rates excluded from out-of-network ERs.

Research hospital options when possible to identify affordable emergency care in your region as an uninsured patient. Location makes a big cost difference.

Avoiding Unnecessary ER Visits

The ER remains essential for true health emergencies, but far too many visits occur for minor concerns. Here are tips to avoid costly, unnecessary ER trips:

• Visit an urgent care center or doctor’s office for basic illness or injuries.
• Call your primary care physician for guidance to evaluate urgency if unsure.
• Use telemedicine apps for on-demand expert consultations.
• Go to retail clinics in major pharmacies for basic care needs.
• Treat small wounds at home or visit an outpatient clinic.
• Allow fevers, vomiting, diarrhea, etc. to improve over 24 hours before seeking ER care.
• Call 911 instead for true emergencies like chest pain, loss of consciousness, etc.

Staying out of the ER unless absolutely necessary is the #1 way for uninsured patients to control costs. Seek care in lower-priced settings when the situation allows.

Final Words

Emergency rooms provide critical, life-saving care but frequently create financial hardship for uninsured patients. Typical ER visits cost hundreds to thousands of dollars out-of-pocket without health coverage.

Always understand your options to keep expenses as low as possible in an urgent medical situation. With the right information and choices, you can get the emergency care you need while minimizing costs.

Frequently Asked Questions

Is emergency care free in the usa.

No, emergency care is not free in the USA, even for those without health insurance coverage. Under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals must medically screen and stabilize patients who come to an emergency room, regardless of their ability to pay.

However, this law only requires urgent stabilizing treatment and does not cancel out hospital charges. Uninsured patients can still receive large medical bills they are responsible for paying.

Hospitals may offer financial assistance or payment plans, but emergency room care is not free. Having health insurance or utilizing lower-cost options like urgent care for non-emergencies is wise to limit expenses as much as possible. But the emergency room always remains an option in true health crises despite costs.

What is the best time to go to the ER?

The best time to visit the emergency room is when you have an urgent medical problem requiring immediate care. This includes potentially life-threatening issues like chest pain, difficulty breathing, sudden numbness/weakness, major trauma or burns, severe bleeding or pain, poisoning, complications of pregnancy, or any situation where you reasonably fear for life or limb without instant treatment.

For these critical matters, the ER provides essential services at any hour of the day or night. However, for non-urgent issues, the ER may not be the wisest choice due to high costs for uninsured patients.

Weekday mornings and afternoons tend to be less crowded if your condition allows flexibility. Always call 911 or have someone drive you for serious emergencies regardless of the hour.

What happens if a tourist gets sick in the USA without insurance?

If a tourist becomes ill or injured while visiting the USA without traveler’s insurance, they can still receive emergency treatment but will face high medical costs. By law, hospitals must medically screen and stabilize patients in the ER regardless of insurance status or ability to pay. However, the uninsured tourist will later receive hospital bills they are responsible for paying.

Tourists in the U.S. should take steps to manage potential medical costs in case of emergency:

• Purchase comprehensive travel insurance covering health emergencies abroad. This is the best option to limit expenses.
• Bring prescription medications and first aid supplies to treat minor issues yourself.
• Carry your passport and any payment methods for healthcare.
• Confirm your home country will cover costs for any government-funded care.
• Ask about discounted rates or financial assistance at U.S. hospitals.
• Request an itemized bill and check for errors after treatment.
• Inquire if the hospital offers interest-free payment plans.
• Consider returning home for any follow-up care or procedures.

With proper preparation, travelers can still enjoy their U.S. visit with less worry about medical costs. But having insurance or access to funds is essential to cover unexpected healthcare needs away from home.

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Emergency Room Visit: When to Go, What to Expect, Wait Times, and Cost

Knowing when and why to go for an emergency room visit can help you plan for care in the event of a medical emergency.

How much does it cost to go to an emergency room?

Emergency Room (ER) costs can vary greatly depending on what type of medical care you need. How much you pay for the visit depends on your health insurance plan. Most health plans may require you to pay something out-of-pocket for an emergency room visit. A visit to the ER may cost more if you have a High-Deductible Health Plan (HDHP) and you have not met your plan’s annual deductible. HDHP's typically offer lower monthly premiums and higher deductibles than traditional health plans. Your plan will start paying for eligible medical expenses once you’ve met the plan’s annual deductible. Here are some tips to pay less out of pocket .

When should I go to an emergency room?

Emergency rooms are often very busy because many people don’t know what type of care they need, so they immediately go to the ER when they are sick or hurt. You should make an emergency room visit for any condition that’s considered life-threatening.

Life-threatening conditions include, but are not limited to, things like a serious allergic reaction, trouble breathing or speaking, disorientation, a loss of consciousness, or any physical trauma.

If you need to be treated for problems that are considered non-life threatening, such as an earache, fever and flu symptoms, minor animal bites, mild asthma, or a mild urinary tract infection, consider seeing your doctor or visiting an urgent care center or convenience care clinic.

What is the cost of an emergency room visit without insurance?

Emergency room costs with or without health insurance can be very high. If you have health insurance, review your plan documents for details on the costs associated with your plan, including your plan deductible, coinsurance, and copay requirements.

If you don’t have insurance, you may be required to pay the full cost of your treatment, which can vary by facility and the type of treatment required. Always plan ahead for sudden sickness, injury, or other medical needs, so you know where to go and how much it could cost. If you need medical care, but it’s not life-threatening you may not have to go to the ER—there are other more affordable options:

• Urgent care center: Staffed by doctors, nurses, and other medical staff who can treat things like earaches, urinary tract infections, minor cuts, nausea, vomiting, etc. Wait times may be shorter and using an urgent care center could save you hundreds of dollars when compared to an ER.
• Convenience care clinic: Walk-in clinics are typically located in a pharmacy (CVS, Walgreens, etc.) or supermarket/retail store (Target, Walmart, etc.). These clinics are staffed with physician assistants and nurse practitioners who can provide care for minor cold, fever, flu, rashes and bruises, head lice, allergies, sinus/ear infections, urinary tract infections, even flu and shingles shots. No appointments are needed, wait times are usually minimal, and a convenience care clinic costs much less than an ER.

Plan ahead for when you need medical care. You may not need an emergency room visit and the bill that could come with it.

What are common emergency room wait times?

Emergency room wait times vary according to hospital and location. Patients in the ER are seen based on how serious their condition is. This means that the patients with life-threatening conditions are treated first, and those with non-life threatening conditions have to wait.

To help reduce ER wait times, health care facilities encourage you to plan ahead for care, so when you’re sick or hurt, you know if the ER is right for your medical condition.

An emergency room visit can take up time and money if your problem is not life-threatening. Consider other care options, such as an urgent care center, convenience care clinic, your doctor, or a virtual doctor visit (video chat/telehealth)—all of which could be faster and save you money out of your own pocket if the medical problem is non-life threatening.

If you have health insurance, be sure to check your plan documents to see what types of care options are eligible for coverage under your plan, including whether or not you need to stay in your plan’s network.

Is taking an ambulance to the emergency room free?

An ambulance ride is not free, but your insurance may cover some of the costs for the ride, as well as the emergency room visit. Check your plan benefits to see what out-of-pocket expenses you are responsible for when it comes to an ambulance ride and a visit to the ER.

Plan ahead for times you may need immediate medical care. Review the details of your health plan so you know the costs for an ER visit should you ever need it. Know when it’s best to go to the emergency room and when going somewhere else, like an urgent care center, convenience care clinic, your doctor, or even a virtual doctor visit (video chat/telehealth), is the right option that may save you time and money.

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The information provided here is for educational purposes only. It does not constitute medical advice and is not a substitute for proper medical care provided by a physician. Cigna Healthcare SM assumes no responsibility for any circumstances arising out of the use, misuse, interpretation or application of this information. Always consult your doctor for appropriate examinations, treatment, testing, and care recommendations. In an emergency, dial 911 or visit the nearest emergency room.

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No Surprises Act Implementation: What to Expect in 2022

Karen Pollitz Published: Dec 10, 2021

• Issue Brief

The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan. 1   The federal government estimates the NSA will apply to about 10 million out-of-network surprise medical bills a year.

The NSA will protect consumers from surprise medical bills by:

• requiring private health plans to cover these out-of-network claims and apply in-network cost sharing. The law applies to both job-based and non-group plans, including grandfathered plans 2
• prohibiting doctors, hospitals, and other covered providers from billing patients more than in-network cost sharing amount for surprise medical bills.

The NSA also establishes a process for determining the payment amount for surprise, out-of-network medical bills, starting with negotiations between plans and providers and, if negotiations don’t succeed, an independent dispute resolution (IDR) process.

Federal agencies published two interim final regulations and another proposed rule this year to implement the law. 3 This brief summarizes key provisions that will take effect in 2022.

New federal protections apply to most surprise bills

Protections will apply to most surprise bills for specific types of services provided in certain settings.

Emergency Services  – Surprise billing protections 4 apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments , and urgent care centers that are licensed to provide emergency care. The federal law also applies to air ambulance transportation (emergency and non-emergency), but not ground ambulance . 5   Emergency care includes screening and stabilizing treatment sought by patients who believe they are experiencing a medical emergency or active labor.

The federal government estimates there are 39.7 million emergency visits annually by patients with private job-based or individually purchased insurance, and of these 18% (or about 7.1 million visits) will involve at least one out-of-network claim.

Post-emergency stabilization services – The NSA defines emergency services to also include post-stabilization services provided in a hospital following an emergency visit. Post-stabilization care is considered emergency care until a physician determines the patient can travel safely to another in-network facility using non-medical transport, that such a facility is available and will accept the transfer, and that the transfer will not cause the patient other unreasonable burdens. The NSA also requires patients must receive written notice and give written consent to be transferred. 6 The federal government estimates each year 4.1 million emergency department visits result in a hospital admission, and that 16% (or about 660,000) of these admissions will involve at least one out-of-network claim.

Non-emergency services provided at in-network facilities – Finally, the NSA covers non-emergency services provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead they bill independently and do not necessarily participate in the same health plan networks.  The federal government estimates that 16% of 11.1 million (or about 1.8 million) in-network non-emergency facility stays for privately insured patients each year involve at least one out-of-network claim.

The regulation broadly defines covered non-emergency services to include treatment, equipment and devices, telemedicine services, imaging and lab services, and preoperative and postoperative services, regardless of whether those services are provided within the facility itself.

The interim final regulation defines “facility” to include hospitals, hospital outpatient departments, and ambulatory surgery centers. It requests public comment on whether additional types of facilities should be added to this definition. Meanwhile, consumers do not have federal protections against surprise bills for non-emergency services provided in other facilities such as birthing centers, clinics, hospice, addiction treatment facilities, nursing homes, or urgent care centers.  Patients seeking care at such facilities may want to ask whether doctors bill independently and whether they are in network.

Doctors and hospitals must not bill patients more than the in-network cost sharing amount for surprise bills

For services covered by the NSA, providers are prohibited from billing patients more than the applicable in-network cost sharing amount; a penalty of up to $10,000 for each violation can apply.

Today, many out-of-network doctors and hospitals bill patients directly for their full, undiscounted fee, leaving to patients to submit the out-of-network claim to their insurance and collect what reimbursement they can. That common billing practice will change starting next year. Providers will need to first find out the patient’s insurance status and then submit the surprise out-of-network bill directly to the health plan. Providers are “encouraged” to include information about whether NSA protections apply on the claim itself (including, whether the patient has consented to waiver her balance billing protections, described below.)  Health plans must respond within 30 days, advising the provider of the applicable in-network cost sharing amount for that claim; cost-sharing generally will be based on the median in-network rate the plan pays for the service. 7 The health plan will send an initial payment to the provider and send the consumer a notice (called an explanation of benefits, or EOB) that it has processed the claim and indicating the in-network cost sharing amount the patient owes the out-of-network provider. Only at this point is the out-of-network provider allowed to send the patient a bill for no more than the in-network cost sharing amount.

How will consumers know if a bill or claim constitutes a surprise medical bill? – It is up to both providers and health plans to identify bills that are protected under the NSA. The regulations also request public comment on whether changes to federal rules governing electronic claims (so-called HIPAA standard claims transactions) are needed to indicate claims for which surprise billing protections apply. 8

Providers and plans also must notify consumers of their surprise medical bill protections. Providers and facilities must post a one-page disclosure notice summarizing NSA surprise billing protections on a public website and give this disclosure to each patient for whom they provide NSA-covered services.  ( Appendix 1 ) This notice must be provided no later than the date when payment is requested, though the regulation specifies it is not required to be included with the bill, itself. Health plans are also required to provide consumers the disclosure notice with every EOB that includes a claim for surprise medical bills.

If a health plan or provider (or both) fail to properly identify a surprise bill, it will be up to the patient to recognize that NSA protections should apply and seek relief.

Some providers can ask consumers to waive rights

An exception to federal surprise billing protections is allowed if patients give prior written consent to waive their rights under the NSA and be billed more by out-of-network providers.  Providers are never allowed to ask patients to waive their rights for emergency services or for certain other non-emergency services or situations described above. Consent must be given voluntarily and cannot be coerced, although providers can refuse care if consent is denied.

Notice and Consent Waiver Not Permitted for:

• Emergency services
• Unforeseen urgent medical needs arising when non-emergent care is furnished
• Ancillary services, including items and services related to emergency medicine, anesthesiology, pathology, radiology, and neonatology
• Items and services provided by assistant surgeons, hospitalists, and intensivists
• Diagnostic services including radiology and lab services
• Items and services provided by an out-of-network provider if there is not another in-network provider who can provide that service in that facility

Federal regulations provide for a standard waiver consent form , improbably titled the “Surprise Billing Protection Form,” ( Appendix 2 ) that must include key information, including

• a statement that the patient is not required to waive protections, and can try to find an in-network provider/facility instead (for post stabilization care, the notice must indicate the name of available in-network providers)
• a statement that the out-of-network provider/facility can refuse to treat if the patient refuses to waive surprise billing protections
• a statement that waiving protections could cost the patient more money in out-of-network charges
• a description of the out-of-network services to be provided, along with billing codes and a good faith (nonbinding) estimate of costs the patient may owe

The law requires that consent must be given at least 72-hours in advance or, if the patient schedules a service less than 72-hours in advance, no later than the day the appointment is made. For same-day scheduled services, regulations permit consent to be given at least 3 hours in advance. It is possible, for example, that an out-of-network doctor could ask an already-hospitalized patient in the morning to waive her NSA protections for a service the doctor schedules to be given later that afternoon.

Providers should not seek consent to waive protections from patients who are impaired or otherwise limited in their ability to make informed decisions.  The waiver form must also be provided in the 15 most common languages in the geographic region where consent is sought; and if the patient’s own language is not among those, qualified interpreter services must be provided. The patient’s signature is required to give consent; no provider signature is required. Consent can be revoked prior to services being provided. The out-of-network provider or facility is required to notify the health plan that patient consent to waive balance billing protections for the claim(s) was appropriately given.

The Departments express the view that consent to waive NSA protections should be obtained only in limited circumstances – where the patient knowingly and purposefully seeks care from an out-of-network provider – and not to circumvent the law’s consumer protections. Even so, the regulation estimates that consumers will give consent to waive NSA protections in 50% of post-stabilization claims and for 95% of non-emergency services provided at in-network facilities. The regulations do not require any data reporting to regulators on the number of consent waivers given or for what services or providers. Agencies asked for comment on whether further limits on the notice-and-consent waivers are advisable.

Some state laws either do not allow waiver of protections or requiring greater advanced notice.

How will enforcement work?

For consumers to be protected, both the health plan and the surprise billing provider will need to comply with the law. If problems arise, consumers might need to seek help from more than one enforcing agency. And, though the NSA is a federal law, states will also have a role in enforcement.

Enforcement against health plans and insurers – The federal government has exclusive enforcement responsibility for most private health plans, though different federal agencies may be involved. States will lead enforcement for state-regulated plans.

• Most Americans under age 65 are covered by private employer-sponsored health plans, with nearly 2/3 of covered workers in self-insured plans that states are preempted from regulating. Enforcement authority over private self-insured employer-sponsored group plans rests with the U.S. Department of Labor (DOL) and Department of Treasury. Fully-insured group plans will be primarily regulated by states
• For fully insured group health plans and individual health insurance, states have primary enforcement authority, with federal fallback enforcement by HHS triggered when states do not substantially enforce. Any information (e.g., complaints, news stories) can serve as the basis for HHS investigating state enforcement.
• For self-insured plans sponsored by non-federal public employers, the U.S. Department of Health and Human Services (HHS) has primary enforcement authority. Agencies estimate 3 million people are enrolled in these plans.
• For the Federal Employees Health Benefits Program (FEHBP), enforcement authority rests with the U.S. Office of Personnel Management (OPM). The FEHBP is the largest employer-sponsored group health plan, coving nearly 9 million federal employees, annuitants and family members.

The NSA requires DOL to conduct audits of claims data from up to 25 group health plans annually to monitor employer-sponsored plan compliance with the NSA and to report to Congress annually on audit findings. HHS also will conduct up to 9 audits annually of compliance by state and local government employer plans and other issuers in states that are not substantially enforcing the NSA. These annual audits will focus primarily on whether plans are following the methodology for calculating QPAs. 9

Enforcement against providers – States have a primary role in enforcing NSA rules against health providers, with federal enforcement as back up. This is true even when the consumer is covered by a federally-regulated health plan. It is yet to be determined which agency(ies) in each state will enforce NSA provider requirements, for example, the attorney general, department of health, hospital commission, or medical licensing boards. In addition, to “proactively identify and address issues of noncompliance,” HHS has proposed that it will conduct on average 200 random or targeted investigations per month into potential violations of NSA requirements by providers, starting in 2022.

Federal vs. state enforcement – This fall, the federal government surveyed states to learn about their authority and intention to enforce each of the major provisions under the NSA. The survey asked states if they will elect or decline to assume enforcement authority on a provision-by-provision basis. States can also enter into a collaborative enforcement agreement with the federal government, under which the state would seek voluntary compliance from health plans or providers and, when it cannot obtain that, refer cases to the federal government for enforcement action. Many states have already enacted some surprise billing protections for consumers in state-regulated plans. Depending on limits of their laws and authority, it is possible some states might decline to enforce NSA protections for certain services (e.g., post-stabilization) or for certain types of health plans (e.g., PPOs vs. HMOs), or with respect to certain providers (e.g., air ambulance). In addition, state laws may be more protective than the NSA in certain respects (for example, a state law might apply to ground ambulance services) in which case a state would enforce its own stronger protections, at least with respect to state-regulated health plans.

It is expected that HHS will make survey results public or otherwise publish a directory of applicable state and federal enforcement agencies. Health plans and providers must give consumers a disclosure notice summarizing protections under the NSA and state laws, and this must include the name and contact information for applicable enforcement agencies. ( Appendix 1 )

If problems do arise, it is conceivable that a patient might need the help of multiple agencies – federal, state, or both. For example:

• If a US DOL-regulated group health plan incorrectly denies a claim for an out-of-network service to which the NSA applies, and as a result, if the provider then incorrectly bills the patient for the entire charge, the consumer might need to rely on US DOL to enforce against the group health plan and on a state agency to enforce against the provider.
• If a patient requires post-stabilization care following an emergency visit and her state surprise billing law covers emergency services only, she might need to rely on the state to enforce protections for the emergency claims and on the federal government for claims involving the post-stabilization care.
• If a patient receives an out-of-network emergency surprise bill while traveling in another state, he might need to request help from the federal government if his home state, which would otherwise enforce NSA rules on providers, declines to enforce against out-of-state providers.

What can consumers do in case of problems?

Health plans, providers and facilities will most likely work in good faith to comply with NSA requirements. Even if compliance rates are high, with 10 million surprise medical bills annually, hundreds of thousands of problems could nonetheless arise. In such cases, it could fall to the consumer to recognize when surprise billing protections should apply and to seek help.

Consumers can appeal health plan denials – NSA gives consumers the right to appeal health plan decisions to incorrectly deny or apply out-of-network cost sharing to surprise medical bills, first to the health plan, and then, if the plan upholds its decision, to an independent external reviewer. NSA interim final regulations added surprise bills to the scope of claims eligible for external appeal, which is otherwise limited to only denials based on medical necessity. NSA regulations made no other changes to current federal standards and processes that can limit consumer access to external appeal, including those that:

• require the health plan to determine which claims are eligible for external appeal
• require employer-sponsored health plans to contract with the external reviewer
• limit access to denial notices in another language for consumers with limited English proficiency

Federal appeals standards apply to most private health plans sponsored by employers, although in some states appeal rights are stronger for consumers in state-regulated health insurance.

Beyond these limitations, appeal rights may not help in many cases because consumers rarely appeal adverse determinations by their health plans. Data reported by qualified health plans sold on HealthCare.gov show less than 2/10 of 1% of denied claims are appealed internally to the health plan, and less than 3% of those appeals make it to external review. There is no reporting requirement specific to surprise medical bill claims and appeals for QHPs, and at present, federal law requirements on employer-sponsored health plans to report data on denied claims have never been implemented.

Consumers can contact “the applicable enforcement entity” when providers incorrectly bill – Providers are required to give consumers written notice describing their federal protections each time they provide a service protected under the NSA. The notice must include contact information for the applicable federal and state enforcement entities; although a provider that inappropriately balance bills for a service subject to the NSA might also fail to provide the required disclosure notice.

A national consumer complaints system will be established – The NSA requires HHS to establish a national complaints system for surprise medical bills, which is currently under development and scheduled to go live on January 1, 2022.

The toll free number for the “No Surprises Help Desk” will be 1-800-985-3059.

A central, no-wrong-door system is contemplated where consumers can register complaints regarding suspected violations by providers and facilities. The HHS system will also accept complaints related to suspected violations by health plans.  It will coordinate with complaints systems operated by US DOL for group health plans and by OPM for the federal employee health plan and with state insurance regulators. Federal agencies are contemplating requirements to include contact information for the national Help Desk on other key documents, such as health plan EOBs, provider bills, or consent waiver forms.

The interim final regulations say HHS will respond to filed complaints within 12 weeks (60 business days), though agency staff have indicated that consumers will receive real-time confirmation when a complaint is filed.  Agency staff also indicate plans to conduct preliminary review of complaints within 3 to 5 days of receipt to determine any additional information that may be needed to process the complaint. Once processed, HHS will refer the consumer to another Federal or State regulatory agency to investigate or, if applicable, inform the complainant of action HHS has taken to resolve the problem or refer the matter for enforcement. It is still to be determined whether HHS will track the outcome of complaints it refers to other agencies, or whether or how HHS will use the complaint system to track compliance by plans and providers or enforcement activities of states. HHS estimates the system will receive 3,600 provider-related complaints annually; it will cost an estimated $16 million to build the online complaints system and ongoing operating costs of $10 million annually.

Consumers can contact their state Consumer Assistance Program (CAP) – The Affordable Care Act (ACA) provided for the establishment of state ombudsman programs or CAPs to educate privately insured consumers about their health coverage and rights and to help consumers resolve problems with health plans, including filing appeals. Forty CAPs were established in 2010, though no federal CAP funding has since been appropriated. Most remain in operation today, at least at reduced levels, and help patients with medical bill problems , including surprise medical bills .  Other legislation pending in Congress – the Build Back Better Act and the FY 2022 Labor-HHS appropriations bill – together could provide $75 million in new funding for CAPs in 2022, enabling states to establish new or expand existing programs. In addition to helping individual consumers resolve problems, CAPs are required to report to HHS on the kinds of problems consumers encounter. This data can inform oversight, as well as policy changes that can prevent problems from happening again.  CMS staff indicate that the national surprise medical bill complaints system will also be able to refer complainants to the CAP in their state for local assistance. 10

How will payments for surprise bills be determined?

The amount paid for surprise out-of-network surprise bills will likely end up close to the median rate that plans pay in-network providers in a geographic area, also known as the qualifying payment amount, or QPA. 11  Under the law, the patient’s cost sharing for a surprise medical bill must be based on the QPA.  Health plans and providers can negotiate privately over the amount to be paid for the surprise bill, and if they can’t agree, either party can ask for an Independent Dispute Resolution (IDR) process to decide the payment amount. However, there are strong incentives for both plans and providers to either rely on the QPA or on private negotiations.

The federal IDR process will be conducted by certified entities chosen by HHS and will resemble so-called baseball-style arbitration. 12 , 13 The plan and provider will each submit their best offer for the out-of-network payment amount for a claim.  The IDR entity begins with the presumption that the QPA is the correct amount but can consider other factors, including patient acuity, the level of training and expertise of the treating provider, the market shares of both parties, and past good faith efforts of both parties to reach a network agreement. The IDR entity then chooses the offer it determines to be most appropriate, which becomes the out-of-network payment for that bill. The IDR will charge a fee for each arbitration and the losing party must pay that fee. (IDR fees can range from $200 to $500 for a single case, and $268 to $670 for multiple or “batch” determinations.) 14

In light of this process and incentives, HHS estimates the IDR process will be invoked for just over 17,300 surprise medical bill claims per year, and for another roughly 4,900 surprise air ambulance bills per year. The Congressional Budget Office also estimates this process will tend to have a dampening effect on the cost of surprise bills; CBO estimates the NSA will reduce private health plan premiums by 0.5% to 1% on average, and reduce the federal deficit by $17 billion over 10 years.   Studies have found that surprise medical bills otherwise increase overall health insurance costs because the ability to balance bill gives certain providers and facilities leverage to negotiate much higher prices with insurers. To the extent that NSA moderates that dynamic, it can reduce health plan costs overall in addition to reducing out-of-pocket costs for individual patients.

Organizations representing providers and air ambulance companies have objected, however, and filed lawsuits urging that regulations should not have created a ‘rebuttable presumption’ in favor of the QPA. It remains to be seen if these actions may result in delayed implementation of the NSA or in changes to regulatory standards and procedures that could result in greater use of the IDR process or the determination of higher out-of-network payments.

The regulations also require detailed monthly reporting to HHS by IDR entities on the cases they receive. Data required to be sent to HHS includes specific information on the parties involved in each arbitration – including their names, market share, and other characteristic – and on the services involved – including the dollar amounts offered by each party, also expressed as a percentage of the QPA. HHS will compile data into quarterly reports that will be publicly available. These reports could provide an additional degree of transparency around surprise medical bills and the characteristics of plans and providers involved in surprise billing disputes.

The No Surprises Act creates important new federal protections against surprise medical bills – a leading cause of affordability concerns for consumers. That this law passed with strong bipartisan support is an indication of the need for these protections. That federal agencies moved swiftly to implement the new law signals intent to make it work as effectively as possible.

The law is highly complex, however, setting coverage and billing standards for a specific subset of private insurance claims that could number 10 million annually. Providers are permitted to ask consumers to waive their NSA protections in some cases. Oversight and enforcement will be conducted by an array of federal and state agencies, some of which are still to be determined, and more than one of which could be involved in any given case of noncompliance.

Monitoring of the law’s impact, as well as compliance, will be accomplished in various ways.  Data reporting by IDR entities will provide some information about prices for surprise bills and the characteristics of plans and providers using the IDR process. Annual health plan audits conducted by federal agencies can also yield information about prices charged and paid for surprise bills. Other targeted audits and investigations can yield information about compliance generally, as can new federal consumer complaints systems. State systems may also yield important data as to how the law is working, such as state complaints systems and analysis of data from all-payer-claims databases. It remains to be seen how these new systems will work, independently and in coordination.

To a large extent, oversight and enforcement will rely on complaints. In order to complain, though, consumers will need to understand that they should not be overbilled for emergency services or for non-emergency out-of-network services while they are in in-network hospitals and facilities.  How public education will be conducted, and how public understanding of new rights will be monitored is yet to be determined. The responsiveness of new complaints systems and how they coordinate will also be important to watch.

Finally, it remains to be seen if any other tools will be employed to monitor trends in the incidence of surprise medical bills, and how effectively the law may work to protect consumers from surprise bills and reduce their out-of-pocket costs. For example, might the federal government exercise its broad authority under the ACA to require transparency data reporting by private health plans? This authority could be used to monitor the incidence of surprise medical bills over time, as well as differences between the QPA and billed or paid out-of-network charges; it could also be used to monitor how frequently providers use consent waivers. Or, will state consumer assistance programs be employed to play a role in educating the public, reporting to regulators on problems that arise and how they might be prevented in the future?

As implementation proceeds (and as federal courts consider legal challenges to the regulations) it is also possible that NSA standards and procedures will be modified further.

• Affordable Care Act
• Private Insurance
• Consumer Protection
• Cost Sharing

Also of Interest

• Data Note: Public Worries About And Experience With Surprise Medical Bills
• Surprise Bills Vary by Diagnosis and Type of Admission
• Ground Ambulance Rides and Potential for Surprise Billing

Video: What to Know About New Ban on Surprise Bills

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Carbon Health Urgent Care, San Mateo - Hillsdale Mall

Carbon health urgent care.

• Mon 9:00 am - 7:00 pm
• Tue 9:00 am - 7:00 pm
• Wed 9:00 am - 7:00 pm
• Thu 9:00 am - 7:00 pm
• Fri 9:00 am - 7:00 pm
• Sat 9:00 am - 7:00 pm
• Sun 9:00 am - 7:00 pm

Friendly Staff

AVAILABLE TIMES

After hour pediatrics, urgent care clinic - kids only, after hour pediatrics.

• Mon 5:00 pm - 10:00 pm
• Tue 5:00 pm - 10:00 pm
• Wed 5:00 pm - 10:00 pm
• Thu 5:00 pm - 10:00 pm
• Fri 5:00 pm - 10:00 pm
• Sat 10:00 am - 10:00 pm
• Sun 10:00 am - 10:00 pm
• May 13 10:00 am - 10:00 pm
• May 14 10:00 am - 10:00 pm
• May 16 10:00 am - 10:00 pm
• May 17 10:00 am - 10:00 pm
• May 20 10:00 am - 10:00 pm
• May 21 10:00 am - 10:00 pm
• May 22 10:00 am - 10:00 pm
• May 23 10:00 am - 10:00 pm
• May 24 10:00 am - 10:00 pm
• May 27 10:00 am - 10:00 pm
• May 28 10:00 am - 10:00 pm

Highly Rated

Dignity Health- GoHealth Urgent Care, Redwood City

Dignity health- gohealth urgent care.

• Mon 8:00 am - 8:00 pm
• Tue 8:00 am - 8:00 pm
• Wed 8:00 am - 8:00 pm
• Thu 8:00 am - 8:00 pm
• Fri 8:00 am - 8:00 pm
• Sat 9:00 am - 5:00 pm
• Sun 9:00 am - 5:00 pm

Short Wait Time

Dignity Health- GoHealth Urgent Care, San Bruno

Dignity Health- GoHealth Urgent Care, Daly City

Carbon Health Urgent Care, SF Stonestown

Sparkling Clean

Dignity Health- GoHealth Urgent Care, Glen Park

Dignity Health- GoHealth Urgent Care, West Portal

Dignity Health- GoHealth Urgent Care, Castro

Dignity Health- GoHealth Urgent Care, Cole Valley

Carbon Health Urgent Care, Irving St.

Carbon Health Urgent Care, Castro

Dignity Health- GoHealth Urgent Care, Market Street

Carbon Health Urgent Care, SF Civic Center

Dignity Health- GoHealth Urgent Care, North Beach

Dignity Health- GoHealth Urgent Care, Lombard

CityHealth, San Leandro Urgent Care

Carbon Health Urgent Care, Santa Clara

Carbon Health Urgent Care, Oakland

• Mon 8:00 am - 6:00 pm
• Tue 8:00 am - 6:00 pm
• Wed 8:00 am - 6:00 pm
• Thu 8:00 am - 6:00 pm
• Fri 8:00 am - 6:00 pm
• Sat 8:00 am - 6:00 pm
• Sun 8:00 am - 6:00 pm

Dignity Health- GoHealth Urgent Care, Piedmont Ave

Discover Half Moon Bay Healthcare with Solv

Solv simplifies your search for healthcare in Half Moon Bay by seamlessly connecting you with urgent care and walk-in clinic options. With Solv, you can easily locate nearby clinics, access their ratings and reviews, view their hours of operation, and directly book same-day appointments with trusted providers. Our platform offers convenient features such as saving your appointment history for instant re-bookings and tracking your health insurance usage and deductible. Whether you're seeking care for sudden illnesses or minor injuries affecting you, your family, or your children, Solv streamlines the process by allowing you to filter by insurance acceptance, pediatric services, and current availability.

What to Expect with Your Visit

When you seek urgent care in Half Moon Bay , anticipate an efficient process designed to address your health concerns. For the best experience, it’s important to properly prepare for your visit and understand the likely expectations once you enter the clinic.

Preparing for Your Visit

A successful urgent care visit starts with good preparation. Here's how you can get ready:

• Where possible, book a visit online with Solv to save time waiting in the clinic
• Bring your ID, insurance card, and an accepted method of payment
• List your current medications, allergies , and any chronic conditions you may have
• Prepare a brief description of your symptoms and concerns, including their onset
• Think of any questions you might have for the healthcare provider

During Your Visit

You'll receive immediate attention from skilled healthcare professionals at the urgent care center focused on promptly diagnosing and treating your condition. Expect:

• A brief wait, depending on the clinic's volume and whether or not you booked ahead with Solv
• Check-in by providing your ID, insurance, reason for your visit, and completing initial registration paperwork
• A consultation with a healthcare provider to discuss your symptoms and medical history
• Possible diagnostic tests (e.g., X-rays or lab tests), if needed

Treatment may include prescriptions, wound care, or other immediate interventions.

Following your visit, ensure you understand home care instructions or medication usage. You might also receive referrals for specialist care or requests for follow-up visits to monitor your condition. Communication with your healthcare provider is key, so don't hesitate to reach out with any post-visit questions or concerns.

Urgent Care FAQs

What is urgent care.

Urgent care is a healthcare service focused on providing immediate, non-life-threatening medical attention. Urgent care centers treat conditions such as sprains, cuts , burns , and common illnesses and offer a range of services, including diagnostic and preventive care like immunizations and physicals . With an estimated 15,000 clinics in the U.S., urgent care centers operate beyond traditional primary care office hours, offering a convenient and lower cost alternative to emergency rooms for urgent but minor health issues. 

What is a walk-in clinic?

A walk-in clinic is a type of healthcare facility that provides medical care to patients without the need for an appointment. These clinics cover a range of services such as urgent care, occupational medicine, and primary care with walk-in availability. They cater to non-emergent health issues, offering a convenient option for accessible medical attention. Walk-in clinics vary from free services provided by government, charity, or foundation-operated facilities to private clinics with affordable rates, serving as a practical alternative for minor illnesses and injuries outside of traditional doctor's offices and emergency rooms.

Do urgent care centers in Half Moon Bay take appointments?

Historically, urgent care centers were strictly an on-demand, walk-in healthcare service. More recently, as consumer behaviors and expectations have evolved, many urgent care clinics have begun offering book ahead visits, allowing consumers to select a same-day or next-day time that works best for their schedule. Use Solv to find a Half Moon Bay urgent care center that offers advanced bookings (or appointments) and book online.

Are Half Moon Bay urgent care centers open after hours?

Yes. Most primary care doctor offices are open during routine work hours, Monday thru Friday, 9:00 am to 5:00 pm. Conversely, most of the urgent care centers in Half Moon Bay are available after hours, on weekends, and many holidays. Typical urgent care hours are 8:00 am to 8:00 pm daily, although location-specific hours may vary.

How much will an urgent care visit in Half Moon Bay cost?

The cost of a visit to an urgent care in Half Moon Bay varies, with cash prices for the base visit generally ranging from $100 to $175. Additional treatments, such as lab tests, X-rays, or immunizations, can increase costs, typically between $50-150 each. If you're using insurance, expect a co-pay between $20 and $50, depending on your plan and whether the clinic is in-network. Prices differ based on location, so it's best to check directly with the urgent care center and your insurance provider for accurate cost estimates.

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Health Insurance Plans in San Francisco, CA

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Compare Health Insurance Rates in San Francisco, CA

Today, health insurance is a necessity for most families. Health insurance helps subscribers pay for a portion of most routine and unexpected medical costs. There are many varieties of health insurance on the market and choosing the right one for an individual’s personal situation can seem like a daunting task. Some plans can pay directly to the care provider while others require the subscriber to pay the provider first and then submit the receipt to be reimbursed through the insurance plan. Wirefly is available to help subscribers compare health insurance plans in San Francisco, CA and receive free quotes online.

Most residents in San Francisco, CA usually receive health insurance through their employer sponsored plan or through private insurance. Senior citizens may be eligible to receive their health insurance through Medicare while families falling into the low-income brackets can usually get their insurance through Medicaid programs. Medicare and Medicaid programs are often less expensive than other private health insurance plans.

Comparing Health Insurance Coverage in San Francisco, CA

It is so hard for a person to predict what he might need in the form of health care services. People can evaluate what has occurred in recent years to anticipate what might happen in the years to come. If an individual is health and does not go to the doctor very often a low-cost plan will probably be adequate. However, if a person suffers from numerous health problems and are forced to go to the doctor regularly, they will need insurance that provides excellent coverage.

Catastrophic only insurance is the cheapest type of insurance offered in San Francisco, CA. Individuals who are healthy and do not need regular visits to the doctor might want this type of insurance coverage. If a person has an emergency, this insurance will pay some of the bill. However, people who regularly participate in high-risk activities or who might have a dangerous profession, will want insurance coverage who will pay for trips to the emergency room or visits to the doctor.

If a person wants a low deductible, he will pay higher premiums for coverage. If an individual wants full coverage health insurance, he will pay a higher price each month. However, the insurance will pay most of the bill when medical issues arise. With full coverage, the insured should be able to see a doctor for whatever is needed, or he will be able to visit the emergency room for drastic situations. Therefore, when considering an insurance plan in San Francisco, CA, people need to look at their way of life and past health problems to determine what they need to pay for health insurance. It is important for people to have basic coverage, and then they can decide what they can afford to add.

What Are The Different Types of Health Insurance Plans in San Francisco, CA

Residents of San Francisco, CA looking for health insurance have a variety of policies to choose from. This allows people from all levels of society to find an insurance plan that will suit their lifestyle, and their current, or future, some of the most common types of health insurance plans include an HMO, a PPO, and a POS.

A Health Maintenance Organization plan or HMO requires you to choose a PCP or primary care physician, to oversee all their healthcare needs. That means if you need to see a specialist, such as a cardiologist or a dermatologist, you will need to see your PCP first and get a referral from them before your insurance will cover the costs. Even though most HMO plans usually cost less, policyholders must choose from a network of doctors for their care, and there are some providers that don’t accept HMO insurance. The upside of this type of plan is that there are usually no deductibles and any out-of-pocket fees you must pay are sensible.

A Preferred Provider Organization or PPO is a popular choice for those in San Francisco, CA who want the freedom to choose from a larger network of providers, and visit a specialist without a referral. While it is advised that those on a PPO plan visit doctors, hospitals, and other healthcare facilities that are within their network, you can get partial coverage for health care services received out-of-network. A PPO plan can be very flexible, but you must pay for these benefits. They have co-payments, deductibles, and limits to how much you can pay out-of-pocket.

A Point of Service plan or POS combines the benefits of an HMO and PPO plan by offering policyholders with a large network of physicians to choose from. If you stay within the network, you will not have to pay out any deductibles, and your co-payments will be affordable. However, if you ever need to see a physician outside the network, you can expect to pay a high deductible and more expensive co-pays.

There are also several non-traditional health insurance plans in San Francisco, CA that some individuals consider to be convenient. These include Health Savings Accounts (HSA), Medical Savings Accounts (MSA), and Health Reimbursement Accounts (HRA). With these plans, money is set aside either by yourself or your employer in a savings account that covers all your medical expenses. The money in this tax-exempt account may be used to pay for everything from surgical procedures to prescriptions. These plans can be very flexible in terms of what the money is used for, and some allow unused funds to be rolled over to the next year.

Breaking Down Health Insurance Costs in San Francisco, CA

The premium is the monthly fee for a health insurance policy in San Francisco, CA. The policyholder pays this amount for coverage even if he doesn’t use it that month. The deductible is the amount that the policyholder pays for healthcare coverage first before the insurance provider pays its portion of the bill.

People sometimes confuse deductibles with out-of-pocket costs, but they’re not the same. The deductible is the amount the policyholder must pay for the year before his insurance provider covers anything, while out-of-pocket costs are how much money the policyholder spends before the provider covers all of the bill.

With a typical health insurance plan in San Francisco, CA, deductibles and out-of-pocket costs reset to $0 at the start of a new calendar year. For example, if a policyholder's plan has a $3,000 deductible and he spends $2,000 in out-of-pocket costs that year, his out-of-pocket expenses go back to $0 on January 1. This isn’t always the case, as there are a few plans that roll over the paid deductible amount from the end of one year to the next.

The co-payment, also known as co-insurance, is the amount the policyholder needs to pay for a service. The amount can vary depending on the service. If a plan has a primary physician visit co-payment of $10, then the policyholder must pay that $10 every time he visits his primary physician. The insurance provider pays for the remaining balance as long as the policyholder has coverage for those services. Co-payments don’t count towards a plan’s deductible.

A plan could have a maximum lifetime benefit, which is the most that the insurance provider will pay out for the policy holder’s healthcare costs. After hitting that mark, the insurance provider won’t pay any more healthcare costs for the policyholder.

A person’s health care options rely quite a bit on his employment status. Employees of large companies can typically sign up for a group health insurance plan. While no one is legally required to sign up for a group plan, these plans tend to cost less than individual plans.

Those who are unemployed or self-employed will need to get private, individual health insurance plans. There are other options available for senior citizens who don’t work and people with low incomes. Seniors can sign up for a Medicare plan for financial assistance from the government. People with low incomes can get government-provided financial assistance through a Medicaid plan.

If a person already has a doctor he likes, he should ask what health insurance plans in San Francisco, CA that doctor can accept. He must also notify the doctor regarding changes to his insurance plan.

Get a Health Insurance Quote in San Francisco, CA Today

Buying health insurance is one of the best ways to care for yourself and your family. There are many different factors that may affect insurance plan coverage and rates. Wirefly simplifies the task of comparing health insurance plans and getting health insurance quotes in San Francisco, CA. Just enter your ZIP code to start.

While it is possible to save money on health insurance in several ways, do not pass on the coverage you may need. For instance, if you plan to have a child in the future, choose a plan that includes maternity coverage to avoid the trouble of obtaining coverage later. Make sure that you do not eliminate coverage you need to save money on premiums. Although insurance premiums are not cheap, out-of-pocket costs for future medical care are potentially many times more costly. Let Wirefly help you find the best insurance plan in San Francisco, CA. Save on health insurance by getting free quotes now.

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Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-.

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet].

Statistical brief #268 costs of emergency department visits in the united states, 2017.

Brian J. Moore , Ph.D. and Lan Liang , Ph.D.

Published: December 8, 2020 .

• Introduction

Emergency department (ED) visits have grown in the United States, with the rate of increase from 1996 to 2013 exceeding that for hospital inpatient care. 1 In 2017, 13.3 percent of the U.S. population incurred at least one expense for an ED visit. 2 Furthermore, more than 50 percent of hospital inpatient stays in 2017 included evidence of ED services prior to admission. 3 Trends in ED volume vary significantly by patient and hospital characteristics, but an examination of nationwide costs by these characteristics has not yet been explored in the literature. 4

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents statistics on the cost of ED visits in the United States using the 2017 Nationwide Emergency Department Sample (NEDS). Total ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS). ED visits include patients treated and released from the ED, as well as those admitted to the same hospital through the ED. Aggregate costs, average costs, and number of ED visits are presented by patient and hospital characteristics. Because of the large sample size of the NEDS data, small differences can be statistically significant. Thus, only percentage differences greater than or equal to 10 percent are discussed in the text.

• There were 144.8 million total emergency department (ED) visits in 2017 with aggregate ED costs totaling $76.3 billion (B).
• Aggregate ED costs were higher for females ($42.6B, 56 percent) than males ($33.7B, 44 percent); 55 percent of total ED visits were for females.
• Average cost per ED visit increased with age, from $290 for patients aged 17 years and younger to $690 for patients aged 65 years and older.
• As community-level income increased, shares of aggregate ED costs decreased and average cost per visit increased.
• In rural areas, one half of ED visit costs were for patients from the lowest income communities.
• The expected payer with the largest share of aggregate costs was private insurance in large metropolitan areas (31.4 percent of $39.5B) and Medicare in micropolitan (34.0 percent of $7.6B) and rural (37.3 percent of $5.5B) areas.
• Patients aged 18–44 years represented the largest share of aggregate ED costs in large metropolitan, small metropolitan, and micropolitan areas (36.4, 34.2, 32.5 percent, respectively). Patients aged 65 years and older represented the largest share of aggregate ED costs in rural areas (32.5 percent).

Aggregate costs for emergency department (ED) visits by patient sex and age group, 2017

Figure 1 presents aggregate ED visit costs by patient sex and age group in 2017 as well as number of ED visits. Estimates of aggregate cost use the product of the number of cases and the average estimated cost per visit to account for records with missing ED charge information. Aggregate cost decompositions among different descriptive statistics or using multiple levels of aggregation in a single computation could lead to slightly different total cost estimates due to the use of slightly different and more specific estimates of the missing information.

Aggregate ED visit costs by patient sex and age, 2017. Abbreviation: ED, emergency department Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Patient age and sex were each missing for <0.1% of (more...)

• Aggregate ED visit costs in 2017 were higher overall for females than for males. Of the $76.3 billion in aggregate ED visit costs in 2017, females accounted for $42.6 billion (55.9 percent) and males accounted for $33.7 billion (44.1 percent). This cost differential was largely driven by a difference in ED visit volume, with females having a larger number of ED visits than males (80.2 vs. 64.6 million visits, or 55.4 vs. 44.6 percent of visits). Females had higher aggregate ED visit costs and more ED visits for all age groups except children. The discrepancy was highest for patients aged 18–44 years, with aggregate ED visit costs for females approximately 50 percent higher than costs for males ($15.9 vs. $10.7 billion), followed by patients aged 65 years and older, for which aggregate ED visit costs were approximately one-third higher for females than for males ($11.5 vs. $8.6 billion).

Costs of ED visits by patient characteristics, 2017

Table 1 presents the aggregate and average costs for ED visits, the number of ED visits, and the distributions of costs and visits, by select patient characteristics in 2017.

Aggregate costs, average costs, and number of ED visits by patient characteristics, 2017.

• In 2017, aggregate ED visit costs totaled $76.3 billion across 144.8 million ED visits, with an average cost per visit of $530. Aggregate ED visit costs totaled $76.3 billion in the United States in 2017, encompassing 144.8 million ED visits with an average cost per visit of $530. Routine discharge was the most frequent disposition from the ED, representing 80.8 percent of aggregate ED costs and a similar share of ED visits. Transfers represented 6.2 percent of aggregate ED costs but just 3.0 percent of ED visit volume because they had the highest average cost of any discharge disposition at $1,100 per ED visit. In contrast, ED visits resulting in an inpatient admission to the same hospital had the lowest average cost of any discharge disposition at $360 per ED visit and represented 9.4 percent of aggregate ED costs and 14.0 percent of ED visits.
• The share of aggregate ED visit costs attributed to patients aged 65 years and older was higher than the share of ED visits for this group, and the average cost per visit was highest among patients aged 65 years and older. Aggregate ED visit costs among patients aged 65 years and older totaled $20.2 billion (26.4 percent of the $76.3 billion total for the entire United States in 2017) despite just 29.2 million ED visits from patients in this age group (20.2 percent of the 144.8 million total). Conversely, the share of aggregate ED costs attributed to patients aged 17 years and younger was substantially lower than this group’s corresponding share of ED visits (10.3 percent of ED costs vs.18.5 percent of ED visits). This differential is due in part to the difference in average cost per visit, which increased with age. The average cost per visit among patients aged 65 years and older was more than twice as high as average costs among patients aged 17 years and younger ($690 vs. $290 per visit).
• Medicaid as the primary expected payer had the lowest average cost per ED visit, more than 50 percent lower than average costs for Medicare and one-third lower than for private insurance. Medicaid as the primary expected payer had an average cost per ED visit that was more than 50 percent lower than average costs per visit for Medicare ($420 vs. $660 per visit) and one-third lower than average costs for private insurance ($420 vs. $560 per visit). Due in part to these differences in average costs by expected payer, Medicare represented 30.1 percent of aggregate ED visit costs but 24.1 percent of total ED visits. In contrast, Medicaid represented 25.0 percent of ED costs but 31.5 percent of ED visits.
• As community-level income increased, the share of aggregate ED visit costs decreased and average cost per ED visit increased. The share of ED visit costs and ED visits decreased as community-level income increased. Patients residing in communities with the lowest income (quartile 1) represented roughly one-third of aggregate ED visit costs and ED visits (31.4 and 34.3 percent, respectively). Patients residing in quartiles 2 and 3 represented approximately one-fourth and one-fifth of aggregate ED visit costs and ED visits, respectively. Patients residing in communities with the highest income (quartile 4) represented less than one-fifth of aggregate ED costs and ED visits (18.1 and 16.0 percent, respectively). In contrast, average cost per ED visit increased as community-level income increased, ranging from $480 in communities with the lowest income (quartile 1) to $600 in communities with the highest income (quartile 4).
• The share of aggregate ED visit costs was highest among patients residing in large metropolitan areas. Aggregate ED visit costs for large metropolitan areas totaled $39.5 billion in 2017, more than half of the $76.3 billion in ED costs for the entire United States. The share of aggregate ED costs in large metropolitan areas was analogous to the overall distribution of ED visits in these areas: 51.8 percent of aggregate ED costs and 50.4 percent of ED visits.

Distribution of aggregate ED visit costs for location of patient residence by patient characteristics, 2017

Figures 2 – 4 present the distribution of aggregate costs for ED visits based on the location of the patient’s residence by age ( Figure 2 ), community-level income ( Figure 3 ), and primary expected payer ( Figure 4 ).

Aggregate ED visit costs by age and patient location, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Patient age and patient location (more...)

Aggregate ED visit costs by primary expected payer and patient location, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not presented. Expected (more...)

Aggregate ED visit costs by community-level income and location of patient’s residence, 2017. Abbreviations: B, billion; ED, emergency department; M, million Notes: Statistics for ED visits with missing or invalid patient characteristics are not (more...)

Figure 2 presents the distribution of aggregate costs for ED visits by patient age based on the location of the patient’s residence in 2017.

• Patients aged 18–44 years represented the largest share of aggregate ED visit costs in all locations except rural areas where patients aged 65 years and older represented the largest share. Compared with other age groups, patients aged 18–44 years represented the largest share of aggregate ED visit costs in large metropolitan areas in 2017 (36.4 percent). The share of ED costs attributed to patients aged 18–44 years also was larger than for other age groups in small metropolitan and micropolitan areas (34.2 and 32.5 percent, respectively). Overall, the share of ED costs attributed to patients aged 18–44 years decreased as urbanization decreased, from 36.4 percent in large metropolitan areas to 29.8 percent in rural areas. In rural areas, patients aged 65 years and older accounted for the largest share of aggregate ED visit costs (32.5 percent) compared with other age groups. The share of ED costs attributed to patients aged 65 years and older increased as urbanization decreased, from 24.7 percent in large metropolitan areas to 32.5 percent in rural areas. The share of aggregate ED visit costs attributed to patients aged 45–64 years and those aged 17 years and younger were similar across all patient locations (approximately 28 and 10 percent, respectively).

Figure 3 presents the distribution of aggregate costs for ED visits by quartile of community-level household income in the patient’s ZIP Code based on the location of the patient’s residence in 2017.

• In large metropolitan areas, patients residing in communities with the highest and lowest incomes represented the largest shares of aggregate ED visit costs. For other locations, patients in communities with lower incomes represented the largest share of ED costs. Patients residing in communities with the highest and lowest incomes (quartiles 4 and 1) accounted for 28.1 and 26.6 percent, respectively, of the $39.5 billion in aggregate ED visit costs in large metropolitan areas in 2017. In contrast, patients residing in communities with the two lowest income quartiles represented the largest share of ED costs for other patient locations (small metropolitan, micropolitan, and rural).
• As urbanization decreased, the share of aggregate ED visit costs for patients in the lowest income quartile increased and the share for those in the highest income quartile decreased. The share of aggregate ED visit costs attributed to patients residing in communities in the lowest income quartile (quartile 1) increased as urbanization decreased, from 26.6 percent in large metropolitan areas to 48.8 percent in rural areas. In contrast, the share of ED visit costs attributed to patients residing in communities in the highest income quartile (quartile 4) decreased as urbanization decreased, from 28.1 percent in large metropolitan areas to 1.2 percent in rural areas.

Figure 4 presents the distribution of aggregate costs for ED visits by primary expected payer based on the location of the patient’s residence in 2017.

• Private insurance as the primary expected payer accounted for the largest share of aggregate ED visit costs among patients living in large metropolitan areas. Medicare represented the largest share of ED costs in micropolitan and rural areas. Compared with other primary expected payers, private insurance represented the largest share of aggregate ED visit costs among those living in large metropolitan areas in 2017 (31.4 percent). The share of ED costs attributed to private insurance decreased as urbanization decreased, from 31.4 percent in large metropolitan areas to 27.9 percent in rural areas. More than one-third of ED visit costs were attributed to Medicare as the primary expected payer in micropolitan and rural areas. The share of ED costs attributed to Medicare increased as urbanization decreased, from 28.0 percent in large metropolitan areas to 37.3 percent in rural areas.

Costs of ED visits by hospital characteristics, 2017

Table 2 presents the aggregate and average costs for ED visits, the number of ED visits, and the distributions of costs and visits, by select hospital characteristics in 2017.

Aggregate costs, average costs, and number of ED visits by hospital characteristics, 2017.

• Aggregate ED visit costs were highest for hospitals located in the South in 2017. Aggregate ED visit costs in the South were $27.5 billion in 2017 (36.1 percent of the total $76.3 billion for the United States). The share of ED visit volume for the South was even larger (40.0 percent of the 144.8 million total visits). The distribution of aggregate ED visit costs across other hospital characteristics largely followed the pattern of the number of ED visits. Aggregate ED costs were highest in private, nonprofit hospitals; teaching hospitals; and hospitals not designated as a trauma center (72.0, 64.1, and 52.5 percent of ED costs, respectively). ED visits at private, for-profit hospitals had lower average costs per visit than did visits at either private, nonprofit or public hospitals ($420 vs. $540 and $550 per visit).
• About Statistical Briefs

Healthcare Cost and Utilization Project (HCUP) Statistical Briefs provide basic descriptive statistics on a variety of topics using HCUP administrative healthcare data. Topics include hospital inpatient, ambulatory surgery, and emergency department use and costs, quality of care, access to care, medical conditions, procedures, and patient populations, among other topics. The reports are intended to generate hypotheses that can be further explored in other research; the reports are not designed to answer in-depth research questions using multivariate methods.

• Data Source

The estimates in this Statistical Brief are based upon data from the HCUP 2017 Nationwide Emergency Department Sample (NEDS).

• Definitions

Types of hospitals included in the HCUP Nationwide Emergency Department Sample

The Nationwide Emergency Department Sample (NEDS) is based on emergency department (ED) data from community acute care hospitals, which are defined as short-term, non-Federal, general, and other specialty hospitals available to the public. Included among community hospitals are pediatric institutions and hospitals that are part of academic medical centers. Excluded are long-term care facilities such as rehabilitation, psychiatric, and alcoholism and chemical dependency hospitals. Hospitals included in the NEDS have EDs, and no more than 90 percent of their ED visits result in admission.

Unit of analysis

The unit of analysis is the ED visit, not a person or patient. This means that a person who is seen in the ED multiple times in 1 year will be counted each time as a separate visit in the ED.

Costs and charges

Total ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS). a Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a cost-to-charge ratio constructed specifically for the hospital ED is used. Hospital charges reflect the amount the hospital billed for the entire ED visit and do not include professional (physician) fees.

Total charges were not available on all NEDS records. About 13 percent of all ED visits (weighted) in the 2017 NEDS were missing information about ED charges, and therefore, ED cost could not be estimated. For ED visits that resulted in admission, 24 percent of records were missing ED charges. For ED visits that did not result in admission, 11 percent of records were missing ED charges. The missing information was concentrated in the West (59 percent of records missing ED charges). For this Statistical Brief, the methodology used for aggregate cost estimation was analogous to what is recommended for the estimation of aggregate charges in the Introduction to the HCUP NEDS documentation. b Aggregate costs were estimated as the product of number of visits and average cost per visit in each reporting category. If a stay was missing total charges, average cost was imputed using the average cost for other stays with the same combination of payer characteristics. Therefore, a comparison of aggregate cost estimates across different tables, figures, or characteristics may result in slight discrepancies.

How HCUP estimates of costs differ from National Health Expenditure Accounts

There are a number of differences between the costs cited in this Statistical Brief and spending as measured in the National Health Expenditure Accounts (NHEA), which are produced annually by CMS. c The largest source of difference comes from the HCUP coverage of ED treatment only in contrast to the NHEA inclusion of inpatient and other outpatient costs associated with other hospital-based outpatient clinics and departments as well. The outpatient portion of hospitals’ activities has been growing steadily and may exceed half of all hospital revenue in recent years. On the basis of the American Hospital Association Annual Survey, 2017 outpatient gross revenues (or charges) were about 49 percent of total hospital gross revenues. d

Smaller sources of differences come from the inclusion in the NHEA of hospitals that are excluded from HCUP. These include Federal hospitals (Department of Defense, Veterans Administration, Indian Health Services, and Department of Justice [prison] hospitals) as well as psychiatric, substance abuse, and long-term care hospitals. A third source of difference lies in the HCUP reliance on billed charges from hospitals to payers, adjusted to provide estimates of costs using hospital-wide cost-to-charge ratios, in contrast to the NHEA measurement of spending or revenue. HCUP costs estimate the amount of money required to produce hospital services, including expenses for wages, salaries, and benefits paid to staff as well as utilities, maintenance, and other similar expenses required to run a hospital. NHEA spending or revenue measures the amount of income received by the hospital for treatment and other services provided, including payments by insurers, patients, or government programs. The difference between revenues and costs includes profit for for-profit hospitals or surpluses for nonprofit hospitals.

Location of patients’ residence

Place of residence is based on the urban-rural classification scheme for U.S. counties developed by the National Center for Health Statistics (NCHS) and based on the Office of Management and Budget (OMB) definition of a metropolitan service area as including a city and a population of at least 50,000 residents. For this Statistical Brief, we collapsed the NCHS categories into four groups according to the following:

Large Metropolitan

• Large Central Metropolitan: Counties in a metropolitan area with 1 million or more residents that satisfy at least one of the following criteria: (1) containing the entire population of the largest principal city of the metropolitan statistical area (MSA), (2) having their entire population contained within the largest principal city of the MSA, or (3) containing at least 250,000 residents of any principal city in the MSA
• Large Fringe Metropolitan: Counties in a metropolitan area with 1 million or more residents that do not qualify as large central metropolitan counties

Small Metropolitan

• Medium Metropolitan: Counties in a metropolitan area of 250,000–999,999 residents
• Small Metropolitan: Counties in a metropolitan area of 50,000–249,999 residents

Micropolitan:

• Micropolitan: Counties in a nonmetropolitan area of 10,000–49,999 residents
• Noncore: Counties in a nonmetropolitan and nonmicropolitan area

Community-level income

Community-level income is based on the median household income of the patient’s ZIP Code of residence. Quartiles are defined so that the total U.S. population is evenly distributed. Cut-offs for the quartiles are determined annually using ZIP Code demographic data obtained from Claritas, a vendor that produces population estimates and projections based on data from the U.S. Census Bureau. e The value ranges for the income quartiles vary by year. The income quartile is missing for patients who are homeless or foreign.

Expected payer

• Medicare: includes fee-for-service and managed care Medicare
• Medicaid: includes fee-for-service and managed care Medicaid
• Private insurance: includes commercial nongovernmental payers, regardless of the type of plan (e.g., private health maintenance organizations [HMOs], preferred provider organizations [PPOs])
• Self-pay/No charge: includes self-pay, no charge, charity, and no expected payment
• Other payers: includes other Federal and local government programs (e.g., TRICARE, CHAMPVA, Indian Health Service, Black Lung, Title V) and Workers’ Compensation

ED visits that were expected to be billed to the State Children’s Health Insurance Program (SCHIP) are included under Medicaid.

• Northeast: Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey, and Pennsylvania
• Midwest: Ohio, Indiana, Illinois, Michigan, Wisconsin, Minnesota, Iowa, Missouri, North Dakota, South Dakota, Nebraska, and Kansas
• South: Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Tennessee, Alabama, Mississippi, Arkansas, Louisiana, Oklahoma, and Texas
• West: Montana, Idaho, Wyoming, Colorado, New Mexico, Arizona, Utah, Nevada, Washington, Oregon, California, Alaska, and Hawaii

Discharge status

Discharge status reflects the disposition of the patient at discharge from the ED and includes the following categories reported in this Statistical Brief: routine (to home); admitted as an inpatient to the same hospital; transfers (transfer to another short-term hospital; other transfers including skilled nursing facility, intermediate care, and another type of facility such as a nursing home); and all other dispositions (home healthcare; against medical advice [AMA]; died in the ED; or destination unknown).

Hospital characteristics

Data on hospital ownership and status as a teaching hospital was obtained from the American Hospital Association (AHA) Annual Survey of Hospitals. Hospital ownership/control includes categories for government nonfederal (public), private not-for-profit (voluntary), and private investor-owned (proprietary). Teaching hospital is defined as having a residency program approved by the American Medical Association, being a member of the Council of Teaching Hospitals, or having a ratio of full-time equivalent interns and residents to beds of 0.25 or higher.

Hospital trauma level

• Level I centers have comprehensive resources, are able to care for the most severely injured, and provide leadership in education and research.
• Level II centers have comprehensive resources and are able to care for the most severely injured, but do not provide leadership in education and research.
• Level III centers provide prompt assessment and resuscitation, emergency surgery, and, if needed, transfer to a level I or II center.
• Level IV/V centers provide trauma support in remote areas in which no higher level of care is available. These centers resuscitate and stabilize patients and arrange transfer to an appropriate trauma facility.

For this Statistical Brief, trauma hospitals were defined as those classified by the ASC/COT as a level I, II, or III trauma center. This is consistent with the classification of trauma centers used in the NEDS. The ACS/COT has a program that verifies hospitals as trauma level I, II, or III. h It is important to note that although all level I, II, and III trauma centers offer a high level of trauma care, there may be differences in the specific services and resources offered by hospitals of different levels. Trauma levels IV and V are designated at the State level (and not by ACS/COT) with varying criteria applied across States.

The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, and private data organizations (HCUP Partners) and the Federal government to create a national information resource of encounter-level healthcare data. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, including cost and quality of health services, medical practice patterns, access to healthcare programs, and outcomes of treatments at the national, State, and local market levels.

• Alaska Department of Health and Social Services
• Alaska State Hospital and Nursing Home Services Association
• Arizona Department of Health Services
• Arkansas Department of Health
• California Office of Statewide Health Planning and Development
• Colorado Hospital Association
• Connecticut Hospital Association
• Delaware Division of Public Health
• District of Columbia Hospital Association
• Florida Agency for Health Care Administration
• Georgia Hospital Association
• Hawaii Laulima Data Alliance
• Hawaii University of Hawai’i at Hilo
• Illinois Department of Public Health
• Indiana Hospital Association
• Iowa Hospital Association
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• Kentucky Cabinet for Health and Family Services
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• Maryland Health Services Cost Review Commission
• Massachusetts Center for Health Information and Analysis
• Michigan Health & Hospital Association
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• Mississippi State Department of Health
• Missouri Hospital Industry Data Institute
• Montana Hospital Association
• Nebraska Hospital Association Services
• Nevada Department of Health and Human
• New Hampshire Department of Health & Human
• New Jersey Department of Health
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• New York State Department of Health
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• North Dakota (data provided by the Minnesota Hospital Association)
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• Vermont Association of Hospitals and Health Systems
• Virginia Health Information
• Washington State Department of Health
• West Virginia Department of Health and Human Resources, West Virginia Health Care Authority
• Wisconsin Department of Health Services
• Wyoming Hospital Association
• About the NEDS

The HCUP Nationwide Emergency Department Sample (NEDS) is a unique and powerful database that yields national estimates of emergency department (ED) visits. The NEDS was constructed using records from both the HCUP State Emergency Department Databases (SEDD) and the State Inpatient Databases (SID). The SEDD capture information on ED visits that do not result in an admission (i.e., patients who were treated in the ED and then released from the ED, or patients who were transferred to another hospital); the SID contain information on patients initially seen in the ED and then admitted to the same hospital. The NEDS was created to enable analyses of ED utilization patterns and support public health professionals, administrators, policymakers, and clinicians in their decision making regarding this critical source of care. The NEDS is produced annually beginning in 2006. Over time, the sampling frame for the NEDS has changed; thus, the number of States contributing to the NEDS varies from year to year. The NEDS is intended for national estimates only; no State-level estimates can be produced. The unweighted sample size for the 2017 NEDS is 33,506,645 (weighted, this represents 144,814,803 ED visits).

• For More Information

For other information on emergency department visits, refer to the HCUP Statistical Briefs located at www.hcup-us.ahrq.gov/reports/statbriefs/sb_ed.jsp .

• HCUP Fast Stats at www.hcup-us.ahrq.gov/faststats/landing.jsp for easy access to the latest HCUP-based statistics for healthcare information topics
• HCUPnet, HCUP’s interactive query system, at www.hcupnet.ahrq.gov/

For more information about HCUP, visit www.hcup-us.ahrq.gov/ .

For a detailed description of HCUP and more information on the design of the Nationwide Emergency Department Sample (NEDS), please refer to the following database documentation:

Agency for Healthcare Research and Quality. Overview of the Nationwide Emergency Department Sample (NEDS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality. Updated December 2019. www.hcup-us.ahrq.gov/nedsoverview.jsp . Accessed February 3, 2020.

• Acknowledgments

The authors would like to acknowledge the contributions of Nils Nordstrand of IBM Watson Health.

The HCUP Cost-to-Charge Ratios (CCRs) for NEDS Files were not publicly available at the time of publication, so an internal version was used in this Statistical Brief.

Agency for Healthcare Research and Quality. HCUP Nationwide Emergency Department Sample (NEDS) Database Documentation. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. Updated April 27, 2020. www ​.hcup-us.ahrq.gov ​/db/nation/neds/nedsdbdocumentation.jsp . Accessed October 27, 2020.

For additional information about the NHEA, see Centers for Medicare & Medicaid Services (CMS). National Health Expenditure Data. CMS website. Updated December 17, 2019. www ​.cms.gov/Research-Statistics-Data-and-Systems ​/Statistics-Trends-and-Reports ​/NationalHealthExpendData/index ​.html?redirect= ​/NationalHealthExpendData/ . Accessed February 3, 2020.

American Hospital Association. TrendWatch Chartbook, 2019. Table 4.2. Distribution of Inpatient vs. Outpatient Revenues, 1995–2017. www ​.aha.org/system/files ​/media/file/2019 ​/11/TrendwatchChartbook-2019-Appendices ​.pdf . Accessed March 19, 2020.

Claritas. Claritas Demographic Profile by ZIP Code. https://claritas360.claritas.com/mybestsegments/. Accessed February 3, 2020.

American Trauma Society. Trauma Information Exchange Program (TIEP). www ​.amtrauma.org/page/TIEP . Accessed June 11, 2020.

MacKenzie EJ, Hoyt DB, Sacra JC, Jurkovich GJ, Carlini AR, Teitelbaum SD, et al. National inventory of hospital trauma centers. JAMA. 2003;289(12):1515–22. [ PubMed : 12672768 ]

American College of Surgeons Committee on Trauma, Verification, Review, and Consultation Program for Hospitals. Additional details are available at www ​.facs.org/quality-programs/trauma/vrc . Accessed July 17, 2020.

Moore BJ (IBM Watson Health), Liang L (AHRQ). Costs of Emergency Department Visits in the United States, 2017. HCUP Statistical Brief #268. December 2020. Agency for Healthcare Research and Quality, Rockville, MD. https://www.hcup-us.ahrq.gov/reports/statbriefs/sb268-ED-Costs-2017.pdf .

• Cite this Page Moore BJ, Liang L. Costs of Emergency Department Visits in the United States, 2017. 2020 Dec 8. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Statistical Brief #268.
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In this Page

• Healthcare Cost and Utilization Project (HCUP)
• Nationwide Inpatient Sample (NIS)
• Kids' Inpatient Database (KID)
• Nationwide Emergency Department Sample (NEDS)
• State Inpatient Databases (SID)
• State Ambulatory Surgery Databases (SASD)
• State Emergency Department Databases (SEDD)
• HCUP Overview
• HCUP Fact Sheet
• HCUP Partners
• HCUP User Support

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• An office visit can cost $50 -$350 or more, depending on what's included. A standard teeth cleaning can cost $70 -$200 ; dental X-rays can cost $20-$250 or more; and an exam by a dentist can be $50-$150 or more. Some or all of these costs may be covered by dental insurance.
• Filling a cavity can cost $50-$300 or more for a silver amalgam filling, and $90-$450 or more for a tooth-colored composite; insurance typically covers all or most of the cost of amalgam fillings, but only part of the composite filling cost. Dental crowns can cost $500-$1,500 or more per tooth for porcelain-fused-to-metal crowns; $600-$2,500 or more for gold or other metal alloys; and $800-$3,000 or more for all-porcelain. Crowns are not covered by insurance if they can be considered cosmetic. A root canal can cost $300-$1,500 for a front tooth; $400-$1,800 for a bicuspid; and $500-$2,000 for a molar Dental insurance might cover 40%-80%, but many plans have an annual maximum of $1,000-$2,000 .
• Pulling a tooth can cost $75-$450 for a simple extraction (the tooth that is fully erupted from the gum), and $150-$650 or more for a surgical extraction (the tooth is broken off at the gum, or covered by gum or bone). Wisdom teeth removal can cost $75-$200 per tooth for a simple extraction; $225-$600 per impacted tooth; and $1,000-$3,000 or more to pull four impacted wisdom teeth in one appointment. Insurance typically covers 70%-80% of standard costs if the extraction is medically necessary.
• A dental bridge can cost $1,000-$3,500 for one or two false teeth attached to the adjacent teeth with metal wings; $1,500-$6,000 for a traditional three-unit bridge (two crowns with one false tooth) or $2,000-$12,000 for a four-unit bridge (two crowns, two false teeth). Dental insurance might cover up to 50% of the costs, but many plans have an annual limit of $1,000-$2,000 . Removable partial dentures start at $300-$500, average about $700 -$1,800, and can cost $2,000-$4,000 for premium materials like gold. Full dentures cost $600-$1,000 for a basic set (upper and lower); $1,000-$3,000 for midrange-quality dentures; and $4,000-$8,000 for a premium set. If dentures are medically necessary, insurance might pay 15%-50% of the costs (up to the plan's annual limit).
• Cosmetic work is typically not covered by dental insurance. Teeth whitening can cost $50-$200 per treatment in a spa, salon or mall kiosk; $100-$500 for dentist-supervised at-home bleaching trays; and $300-$1,000 or more for in-office treatments. Dental veneers can cost $500-$1,300 per tooth; veneers on four front teeth can be $2,000-$4,500 or more. Tooth contouring (removing minute amounts of enamel) can cost $50-$500 per tooth. Cosmetic dental bonding (using tooth-colored resin to improve the look of a discolored or chipped tooth, or to fill gaps) can cost $100-$1,000 per tooth but averages $300-$600 .
• Dental implants (a titanium post surgically inserted into the jawbone, and after the site heals a crown, bridge or denture is attached) start at about $1,000-$3,000, and costs increase depending on the type of replacement tooth or teeth, and whether additional procedures like extractions or a bone graft are needed. An implant topped by a crown can cost $1,500-$13,000 or more; two to six implants with a bridge can cost $3,500-$30,000 or more; and four to 12 implants with a set of denture plates can cost $7,000-$90,000 or more. Full-mouth reconstruction using a wide variety of dental procedures can cost $15,000-$40,000, but if extensive reconstruction is needed it can be $45,000-$80,000 or more. Dental insurance might cover some or all of the costs of specific procedures that are considered necessary for medical or structural reasons, like root canals, but not cosmetic procedures like veneers or teeth whitening.
• Ask if there will be any related costs. Some dentists include the cost of an initial exam, follow-up visits and X-rays in the quoted price for a specific procedure, but many do not.
• The National Institute of Dental and Craniofacial Research has tips for finding low-cost dental care[ 1 ] .
• WedMD lists things to consider when choosing a dentist[ 2 ] .
• If the patient has dental insurance, the insurance company will provide a list of approved dentists. Or get referrals to local dentists from the American Dental Association[ 3 ] ; the American Academy of Cosmetic Dentists[ 4 ] ; the American College of Prosthodontists[ 5 ] for a specialist in replacing teeth; the American Academy of Periodontology[ 6 ] for gum specialists; or the American Association of Oral and Maxillofacial Surgeons[ 7 ] .
•   www.nidcr.nih.gov/oralhealth/popularpublications/findinglowcostdentalcare/
•   www.webmd.com/oral-health/guide/finding-dentist
•   www.mouthhealthy.org/en/find-a-dentist.aspx
•   www.aacd.com/index.php?module=aacd.websiteforms&cmd=memberreferral
•   www.gotoapro.org/find-a-prosthodontist/
•   www.perio.org/?q=locator-advanced
•   www.aaoms.org/findoms.php