emergency room visit no insurance cost

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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• An emergency room visit typically is covered by health insurance. For patients covered by health insurance, out-of-pocket cost for an emergency room visit typically consists of a copay, usually $50-$150 or more, which often is waived if the patient is admitted to the hospital. Depending on the plan, costs might include coinsurance of 10% to 50%.
• For patients without health insurance, an emergency room visit typically costs from $150-$3,000 or more, depending on the severity of the condition and what diagnostic tests and treatment are performed. In some cases, especially where critical care is required and/or a procedure or surgery is performed, the cost could reach $20,000 or more. For example, at Park Nicollet Methodist Hospital in Minnesota, a low-level emergency room visit, such as for a minor laceration, a skin rash or a minor viral infection, costs about $150 ; a moderate-level visit, such as for a urinary tract infection with fever or a head injury without neurological symptoms, about $400 ; and a high-level visit, such as for chest pains that require multiple diagnostic tests or treatments, or severe burns or ingestion of a toxic substance, about $1,000, not including the doctor fees. At Dartmouth-Hitchcock Medical Center[ 1 ] , a low-level emergency room visit costs about $220, including hospital charge and doctor fee, with the uninsured discount, while a moderate-level visit costs about $610 and a high-level visit about $1,400 .
• Services, diagnostic tests and laboratory fees add to the final bill. For example, Wooster Community Hospital, in Ohio, charges about $170 for a simple suture, $200 for a complex suture, about $170 for a minor procedure and about $400 for a major procedure, not including doctor fees, medicine or supplies.
• A doctor fee could add hundreds or thousands of dollars to the final cost. For example, at Grand Lake Health System[ 2 ] in Ohio, an emergency room doctor charges about $100 for basic care, such as a wound recheck or simple laceration repair; about $300 for mid-level care, such as treatment of a simple fracture; about $870 for advanced-level care, such as frequent monitoring of vital signs and ordering multiple diagnostic tests, administering sedation or a blood transfusion for a seriously injured or ill patient; and about $1,450 for critical care, such as major trauma care or major burn care that could include chest tube insertion and management of IV medications and ventilator for a patient with a complex, life-threatening condition. At the Kettering Health Network, in Ohio, a low-level visit costs about $350, a high-level visit costs about $2,000 and critical care costs almost $1,700 for the first hour and $460 for each additional half hour; ER procedures or surgeries cost $460-$2,300 .
• According to the U.S. Agency for Healthcare Research and Quality[ 3 ] the average emergency room expense in 2008 was $1,265 .
• According to the U.S. Centers for Disease Control and Prevention, in 2008, about 18%of emergency room patients waited less than 15 minutes to see a doctor, about 37%waited 15 minutes to an hour, about 15% waited one to two hours, about 5% waited two to three hours, about 2% waited three to four hours, and about 1.5% waited four to six hours.
• In some cases, the doctor might recommend the patient be admitted to the hospital. The American College of Emergency Physicians Foundation offers a guide[ 4 ] on what to expect.
• An ambulance ride typically costs $400-$1,200 or more, depending on the location and services performed.
• An urgent care center offers substantial savings for more minor ailments. DukeHealth.org offers a guide[ 5 ] on when to seek urgent care. An urgent care visit typically costs between 20% and 50% of the cost of an emergency room visit. MainStreetMedica.com offers a cost-comparison tool for common ailments.
• Hospitals often offer discounts of up to 50% or more for self-pay/uninsured emergency room patients. For example, Ventura County Medical Center[ 6 ] in California offers ER visits, including the doctor fee and emergency room fee but not including lab tests, X-rays or procedures, for $150 for patients up to 200% of the federal poverty level, for $225 for patients between 200% and 500% of the federal poverty level and $350 for patients from 500% to 700% of the federal poverty level.
• The American College of Emergency Physicians Foundation offers a primer[ 7 ] on when to go to the emergency room.
• In most cases, it is recommended to go to the nearest emergency room. The U.S. Department of Health and Human Services offers a hospital-comparison tool[ 8 ] that lists hospitals near a chosen zip code.
•   patients.dartmouth-hitchcock.org/billing_questions/out_of_pocket_estimator_dhmc.ht...
•   www.grandlakehealth.org/index.php?option=com_content&view=article&id=106&Itemid=60
•   meps.ahrq.gov/mepsweb/data_stats/tables_compendia_hh_interactive.jsp?_SERVICE=MEPS...
•   www.EmergencyCareforYou.org/VitalCareMagazine/ER101/Default.aspx?id=1288
•   www.dukehealth.org/health_library/health_articles/wheretogo
•   resources.vchca.org/documents/SELF%20PAY%20DISCOUNT%20GRID%20-%20BOARD%20LETTER%20...
•   www.EmergencyCareforYou.org/YourHealth/AboutEmergencies/Default.aspx?id=26018
•   www.medicare.gov/hospitalcompare/(S(efntd2saaeir2l5pgarwuvvg))/search.aspx?AspxAut...

Why Did My Emergency Room Visit Cost So Much?

Emergency room visits are notoriously expensive. Just a few hours in the ER can cost you thousands of dollars, with or without insurance.

But how is your ER visit cost calculated, and how can you tell whether your hospital bill is correct? 

We scored some insider tips from Goodbill medical coding expert Christine Fries, who has analyzed thousands of ER hospital bills for accuracy. Here are answers to frequently asked questions we get from Goodbill customers about how to understand and vet ER visit costs.

Why did I get 2 bills for my ER visit?

Patients are usually surprised when their first ER hospital bill is quickly followed by a separate hospital bill with similar-sounding charges but different amounts. This is normal and a byproduct of how hospitals bill patients for the services rendered at the hospital, Fries says. 

The institutional bill, also known as the facility bill, charges you for the procedures, tests, and administrative costs from the hospital. 

The professional bill, also known as the physician bill, charges you for the work and time of the physician who treated you. This generally includes services from doctors, anesthesiologists, or specialists who are affiliated with the hospital but aren’t employed by the hospital. 

Expect to get two bills from your ER visit — one for facility charges, and the other for professional or physician charges.

For more information on the different types of hospital bills, see our itemized bill guide . Goodbill currently helps patients negotiate institutional bills, not professional bills, so our guidance below pertains to institutional bills only. 

My diagnosis turned out to be minor. Why was I charged so much?

It’s important to remember that your ER visit costs are based on the symptoms you first describe upon entering the hospital, not your eventual diagnosis, Fries says.

When a patient walks into the emergency room complaining of chest pains, for example, the hospital’s objective is to run tests and administer procedures that can help rule out life-threatening conditions. Even if the doctor ends up discharging the patient with a non life-threatening diagnosis like indigestion, the hospital has already spent the resources to rule out more severe possibilities like a heart attack.

Your ER visit costs are based on the symptoms you first describe upon entering the hospital, not your eventual diagnosis.

“Look at your symptoms first, not what you were diagnosed with,” Fries says. “The level of your ER visit is guided by the symptoms you described, and by the tests the hospital thought were needed based on those symptoms.”

Why was I charged for an ‘ER Visit Level’ 3, 4, or 5? Is this based on severity?

Hospitals will bill you for a line item called “ER Visit Level” that is based on the complexity of your treatment. ER visit levels range from 1-5: ER visit level 1 is the most mild, while ER visit level 5 is the most severe. The level also determines how much the hospital can charge you, from least expensive to most expensive. You may sometimes hear ER visit levels described by their corresponding Current Procedural Terminology (CPT) codes of 99281, 99282, 99283, 99284 and 99285. 

To decide the proper ER visit level, hospitals typically follow certain guidelines from the American College of Emergency Physicians (ACEP) . ER level 1-2 visits are reserved for treatment of mild cases like bug bites and sunburns. The majority of ER visits fall between ER visit levels 3-5, with ER visit level 4 being the most common, Fries says.

“Most emergency room claims will qualify as a 99284, because you only need something as simple as IV fluids to get you there,” Fries says.

The majority of ER visits fall between ER visit levels 3-5, with ER visit level 4 being the most common.

Here’s a simple rule of thumb for determining whether your ER visit level was correctly assigned.

ER Visit Level 4

‍ An ER visit level 4 typically requires a minimum of two diagnostic tests — like a lab plus an EKG, or a lab plus an X-ray. Or, any administration of fluids through IV will automatically qualify your visit as an ER visit level 4.

ER Visit Level 5

‍ An ER visit level 5 typically requires a minimum of three diagnostic tests — for example, a lab plus EKG and X-ray. Or, any type of imaging scan like a CT scan or MRI where a patient must ingest or be injected with contrast material, will automatically qualify your visit as an ER visit level 5.

‍ I’m not pregnant. Why did I get charged for a pregnancy test?

Many female patients get frustrated when they’re charged for a pregnancy test, even when they’re absolutely certain they’re not pregnant. But this is standard practice and a way for hospitals to protect against unknown pregnancies, Fries says. 

If you’re an adult pre-menopausal female, you can count on being asked to do a urine or blood pregnancy test before the hospital will treat you. It’s too risky to both the patient and hospital to administer injections, scans or drugs in the off chance that a patient is unknowingly pregnant. 

If you're a female, expect to get a pregnancy test during your ER visit — even if you're not pregnant.

On your itemized ER bill, your pregnancy test will usually show up with a description like “human chorionic gonadotropin (hCG),” which is the hormone being tested. This charge will generally fall under the CPT codes 84702 or 84703 if it’s a blood test, or 81025 if it’s a urine test. 

What are some other common ER services I might see on my hospital bill? 

Here are a few common procedure names that often show up in your ER visit costs, and what they mean in plain English:

Metabolic panel

‍ This is a bundle of lab tests run from a single blood draw. Patients may get a “basic” metabolic panel under CPT code 80048, or a “comprehensive” metabolic panel under CPT code 80053. These panels cover a set of individual tests that might otherwise be individually charged. For example, a “comprehensive” metabolic panel must include testing for all of the following: 

• Carbon dioxide
• Phosphatase, alkaline
• Transferase, alanine amino
• Transferase, aspartate amino
• Urea nitrogen

Venipuncture

‍ Any time you get your blood drawn through a needle, this charge under CPT code 36415 is the line item that bills you for the needle.

‍ This test under CPT code 83690 measures your levels of lipase, which is an enzyme that helps break down fat in your intestines. Your lipase levels may be elevated if you have pancreatitis, which is an inflammation of the pancreas gland.  

What are some ER visit cost errors I should look out for?

When analyzing a patient’s ER visit costs for errors, Fries says she goes straight to one place first: Hydration services. If you recall being administered fluids through an IV bag, chances are you got hydration services during your ER visit.

“Hydration services should always be questioned,” Fries says.

Coding guidelines require that the two CPT codes for this service, 96360 and 96361, meet a minimum time requirement of 31 minutes in order for one unit to be billed. These 31 minutes must also be “stand alone” — meaning that the administration of the service cannot overlap with any other type of infusion service. Often, hospitals don’t meet these requirements, rendering the charge unbillable.

Hydration services are a common source of errors in ER hospital visit costs. You can tell if you're being overcharged by checking your medical record.

To verify whether you’re being charged properly, you’ll need your medical record, Fries says. Look for hydration service “start” and “stop” times, which are usually included in the Medication Administration Report (MAR) section of your record. If the hydration service duration is less than 31 minutes of standalone time, you have a strong case to dispute the charge with your hospital. To find out how to get your medical records online, visit our Medical Records guide .

I don’t see any CPT codes on my bill. How can I get them?

CPT codes are the common language used across all hospitals to describe a certain procedure. They’re what enables our medical coders at Goodbill to analyze hospital bills for errors, line item by line item. They also help us compare prices apples-to-apples across hospitals.

CPT codes are the standard language used to describe a certain procedure across all hospitals. They're key to helping you identify errors or inflated charges in your ER hospital bill.

Unfortunately, the hospital bill you get in the mail is most likely a consolidated summary of your ER visit costs and won’t include CPT codes. You’ll need an “itemized bill” from your hospital to get a line-by-line breakdown of each charge, complete with the CPT code and cost. 

The good news is that you’re legally entitled under HIPAA to get access to this information. To learn more about your patient rights and how to obtain your itemized bill, check out our Patient Right of Access guide .

Are there other topics you’d like us to cover? Email us at [email protected] and let us know.

Guides, news, and articles to help you tackle hospital bills.

How to Negotiate Your Hospital Bill

Read our expert tips on how to negotiate your hospital bill to save up to thousands of dollars.

Itemized Bill: Your Key to Negotiating

Itemized bills provide key details that can help you negotiate your hospital bill.

Can Hospital Bills Affect My Credit?

You have time before your bill can go to collections or affect your credit.

Negotiating hospital bills has never been this easy.

Building trust and confidence into every health care transaction.

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Visiting the emergency room (ER) can be a stressful and overwhelming experience, especially when you don’t have health insurance. Many people are unsure of what to expect when it comes to the cost of an ER visit without insurance. In this article, we will provide an in-depth look at the factors that influence the cost of an uninsured ER visit, the average expenses you can expect to incur, and some tips on how to navigate the financial aspects of an emergency medical situation. Whether you’re facing an unexpected medical emergency or simply want to be prepared for the future, this article will give you the information you need to understand the costs associated with an ER visit without insurance.

Table of Contents

Understanding the cost of an er visit without insurance, factors that affect er visit costs for uninsured patients, tips for managing emergency room expenses without insurance, negotiating your er bill and finding financial assistance programs, the conclusion.

When it comes to seeking medical attention in an emergency room, one thing is certain: it can be costly, especially if you don’t have insurance. The price for treatment can vary greatly depending on the severity of your condition, the tests and procedures needed, and the hospital you visit. On average, an ER visit can range from $150 to $3,000 or more for basic care, and can easily exceed $20,000 for more serious conditions that require hospitalization or surgery.

It’s important to understand that ER charges are often higher than those for the same services provided in a doctor’s office or urgent care center , due to the higher overhead costs associated with operating an emergency department. Additionally, many hospitals charge a facility fee, which covers the cost of maintaining the emergency room, medical equipment, and staff. This fee can range from a few hundred dollars to several thousand dollars, and is separate from the cost of medical treatment.

Here is a breakdown of some common ER services and their average costs without insurance:

• Basic ER visit : $150 – $3,000
• Lab tests : $100 – $3,000
• X-rays : $150 – $1,000
• CT scans : $500 – $3,000
• MRIs : $1,000 – $5,000
• Sutures : $150 – $2,500
• Emergency surgery : $5,000 – $50,000+

It’s worth noting that these prices are just estimates and can vary widely depending on the hospital and its location. In some cases, hospitals may offer discounts or payment plans for uninsured patients. It’s always a good idea to ask about these options and to inquire about the costs of services before receiving treatment, if possible. Remember, the best way to avoid high ER costs is to have health insurance coverage, but if that’s not an option, understanding the potential costs can help you make informed decisions about your care.

When it comes to visiting the ER without insurance, there are several factors that can impact the overall cost. Firstly, the severity of the condition being treated plays a significant role in the final bill. For example, a simple sprain or minor cut may only result in a few hundred dollars in charges, while a more serious condition such as a heart attack or stroke can easily rack up tens of thousands of dollars in medical expenses.

Another important factor is the location of the hospital. Hospitals in urban areas tend to charge more for emergency room visits than those in rural areas. Additionally, some hospitals may have higher costs due to their reputation or the level of specialized care they offer.

Here are some other factors that can affect the cost of an ER visit for uninsured patients:

• The time of day or night the visit occurs
• The number of tests and procedures performed
• The amount of medication administered
• Any additional services required, such as ambulance transportation or overnight observation

It’s important to note that these are just estimates and the actual cost can vary greatly depending on individual circumstances. Uninsured patients should always inquire about financial assistance options and potential payment plans to help manage the cost of an ER visit.

Visiting the emergency room without insurance can often result in high medical bills that can be difficult to manage. However, there are several ways you can reduce the costs and avoid being overwhelmed by the expenses.

Research and Compare Prices

• Not all emergency rooms have the same pricing. Before deciding where to go, research the prices of different emergency rooms in your area. Some hospitals provide pricing information on their website, or you can call and ask for an estimate.
• Consider urgent care centers for non -life-threatening medical issues . The cost of an urgent care visit is usually lower than the emergency room.

Negotiate Payment Plans

• Ask the hospital if they offer a payment plan. Many hospitals are willing to work with patients to create a payment plan that fits their budget.
• Some hospitals offer financial assistance programs for patients without insurance. These programs may reduce the total cost of your bill or provide a discount.

Remember, the best way to manage emergency room expenses is to be prepared. Make sure to have some money saved for unexpected medical costs and always ask questions about the costs before receiving treatment.

If you’ve ever found yourself in the emergency room without insurance, you know that the cost can be staggering. On average, an ER visit can range anywhere from $150 to $3,000 or more , depending on the severity of your condition and the tests and treatments required. However, there are ways to negotiate your bill and find financial assistance programs to help alleviate the burden.

Firstly, it’s important to know that hospitals are often willing to work with patients on their bills. Consider asking for an itemized bill and review it carefully for any errors or charges for services you didn’t receive. If you find any discrepancies, don’t hesitate to bring them up with the billing department. Additionally, you can negotiate a payment plan or ask for a discount based on your financial situation. Many hospitals offer financial assistance programs for uninsured patients, so be sure to inquire about what options are available to you.

Here are some steps you can take to negotiate your ER bill:

• Request an itemized bill and review it thoroughly
• Contact the billing department to discuss errors or discrepancies
• Ask about payment plans or discounts based on your financial situation
• Inquire about financial assistance programs offered by the hospital

Furthermore, there are various financial assistance programs available at the state and federal level that can help cover the cost of your ER visit. For example, Medicaid and the Children’s Health Insurance Program (CHIP) are two programs that provide assistance to eligible individuals. Additionally, some hospitals have their own charity care programs that can help cover the costs for uninsured patients who meet certain income guidelines. It’s worth researching and applying for these programs to help ease the financial burden of your ER visit.

Q: How much does an ER visit cost without insurance? A: The cost of an ER visit without insurance can vary widely depending on the location and the services received. On average, the cost can range from $150 to $3,000 or more.

Q: What factors influence the cost of an ER visit without insurance? A: The cost of an ER visit without insurance is influenced by factors such as the severity of the injury or illness, the procedures and tests performed, the medications administered, and the hospital’s pricing.

Q: Can I negotiate the cost of an ER visit without insurance? A: Yes, it is possible to negotiate the cost of an ER visit without insurance. Many hospitals have financial assistance programs or may be willing to negotiate a payment plan.

Q: What should I do if I can’t afford the cost of an ER visit without insurance? A: If you cannot afford the cost of an ER visit without insurance, it is important to communicate with the hospital’s billing department. They may be able to offer financial assistance, payment plans, or discounts.

Q: Are there alternative options for individuals without insurance who need medical care? A: Yes, there are alternative options for individuals without insurance who need medical care, such as urgent care centers, community health clinics, and telemedicine services. These options may offer more affordable care for non-life-threatening conditions.

Q: Are there any resources available to help individuals estimate the cost of an ER visit without insurance? A: Yes, there are resources available to help individuals estimate the cost of an ER visit without insurance, such as healthcare cost transparency websites and hospital cost estimation tools. These resources can provide a general idea of the potential costs to expect.

In conclusion, the cost of an emergency room visit without insurance can vary greatly depending on the severity of the situation and the specific services required. It is important to be aware of the potential financial burden of an ER visit and to explore other options for care when possible. While the cost may be daunting, it is essential to seek medical attention in emergency situations and to consider options for obtaining health insurance to help mitigate the financial impact of unexpected medical expenses. We hope that this information has provided clarity on the potential costs and implications of seeking emergency care without insurance.

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

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Vox reporter Sarah Kliff spent over a year reading thousands of ER bills and investigating the reasons behind the costs, including hidden fees, overpriced supplies and out-of-network doctors.

Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.

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Can You Go to the ER Without Health Insurance?

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Ah, you've found the loophole! There's so much talk about how terrible consumer protection is in regards to insurance and the entire health care system in the United States, that we've overlooked the amazingly simple fix. Just don't buy insurance, and waltz into the ER every time you need an antibiotic or want that checkup. Those docs have to treat you or be stripped of their license under some Hippocratic Oath , right? You've entirely scammed the system!

So it turns out, that loophole has been found, stitched up, covered with concrete and surrounded by bulletproof glass. The health care industry has been happy to charge for treatment and medicine since darn near the beginning of time, whether it's an emergency or not. If you don't have insurance to cover the cost of a visit, the joke really is on you: You're responsible for the bill. Period.

Now if you're looking back and forth in horror between the bloody stump where your hand used to be and your empty bank account, please take heed: You should absolutely go to the emergency room, even if you don't have thousands of dollars need to pay for treatment. While hospitals, providers and the like will still charge you, they're not going to run a credit report or ask for a down payment before care.

In fact, the federal Emergency Medical Treatment and Labor Act (EMTALA) is designed to guarantee a person's right to receive emergency treatment, regardless of if they can pay or not [source: CMS ]. It basically says that if you need emergency medicine, you must be treated at any emergency room, to the best of the staff's ability, until you're in stable condition for transfer. It's also designed to make sure that private hospitals aren't "dumping" uninsured or Medicaid patients on public hospitals, by transferring folks before treatment.

So sure: You'll get treated at an ER, regardless of insurance. But that doesn't mean that you can walk out without a bruise in the wallet. Remember that if you have insurance, a hospital or provider charges your insurance company for your visit. The insurance company pays whatever your plan specifies, and you are responsible for whatever balance is leftover. Without insurance? You're just looking at the whole of the bill, and it can be a whopper. And do remember that the cost of treatment and procedures varies wildly from hospital to hospital [source: Caldwell et al. ].

Since the Affordable Care Act went into effect, fewer Americans are walking into the ER without insurance. But if you're still a holdout, do know that you're still going to have to pay your bill, although the ACA does have provisions that ensures hospitals only use things like liens or wage garnishing after they make a patient aware of available assistance [source: Brino ].

ER No Insurance FAQ

What happens if you go to the er without insurance, do hospitals have to treat you without insurance, how much does it cost to go to the er without insurance, is it cheaper to go to urgent care or er without insurance, how does emergency room billing work if you're uninsured, can you negotiate an er bill, lots more information, related articles.

• How Mobile Medicine Works
• 10 Conditions the ER Can't Help You With
• 10 Injury Treatment Priorities at the Emergency Room
• 10 Jobs that Will Likely Send You to the ER
• 10 Most Common Reasons for an ER Visit
• Brino, Anthony. "New Affordable Care Act rules target aggressive billing, collections." Healthcare Finance. (April 9, 2015) http://www.healthcarefinancenews.com/news/new-affordable-care-act-rules-target-aggressive-billing-collections
• Caldwell, Nolan et al. "'How Much Will I Get Charged For This?' Patient Charges for Top Ten Diagnoses in the Emergency Department." PLOS One. Feb. 27, 2013. (April 9, 2015) http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0055491
• Centers for Medicare and Medicaid Services (CMS). "Emergency Medical Treatment & Labor Act (EMTALA)." March 26, 2012. (April 9, 2015) http://www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/01_overview.asp
• Murphy, Tim. "No, You Can't Just Go to the Emergency Room -- Unless You Want to Go Broke." Mother Jones. Oct. 18, 2013. (April 9, 2015) http://www.motherjones.com/politics/2013/10/emergency-rooms-instead-health-insurance
• National Public Radio. "FAQ: Understanding The Health Insurance Mandate And Penalties For Going Uninsured." Oct. 11, 2013. (April 9, 2015) http://www.npr.org/2013/10/11/230851737/faq-understanding-the-health-insurance-mandate-and-penalties-for-going-uninsured
• Prater, Connie. "IRS to Tax-Exempt Hospitals: Go Easier on Medical Debt Collection." FoxBusiness. July 5, 2012. (April 9, 2015) http://www.foxbusiness.com/personal-finance/2012/07/02/irs-to-tax-exempt-hospitals-go-easier-on-medical-debt-collection/
• Zadrozny, Brandy. "Obamacare Has a New Problem: It Won't Fix Emergency Rooms." The Daily Beast. Jan. 2, 2014. (April 9, 2015) http://www.thedailybeast.com/articles/2014/01/02/obamacare-has-a-new-problem-it-won-t-fix-emergency-rooms.html

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What Happens if I Go to the E.R. Without Insurance?

Expert Reviewed

Our panel of insurance experts has reviewed the content to ensure that our reporting and statistics are accurate, easy to understand and unbiased.

SmartFinancial Offers Unbiased, Fact-based Information. Our fact-checked articles are intended to educate insurance shoppers so they can make the right buying decisions. Learn More

An emergency room (ER) visit can cost up to $2,700 if you don’t have insurance. With insurance, the average cost decreases to $1,150.

Keep reading to learn more about what goes into how much an emergency room visit is without insurance. We also share tips on ways to lower your ER bill and your options for financial aid if you need it.

On This Page

How Much Does It Cost To Visit an Emergency Room Without Insurance?

How does an emergency room work, does health insurance cover emergency room visits, how do i save at the er, how to get health insurance that will cover an emergency room visit.

The average cost of visiting the emergency room without health insurance will vary depending on the facility and services used. For instance, UnitedHealthcare places the average cost at $2,700 for ER visits. [1] Consider that a visit to the emergency room for a minor injury such as a sprained ankle or a cut that requires stitches can cost several hundred dollars. [2] On the other hand, a visit for a heart attack can cost over $28,000. [3] Below is a table showing breakdowns of costs for common emergency room conditions and services: [2]

The average cost will also vary by state since the cost of services, treatment and the cost of living will depend on where you live. 

In addition to the cost of the services provided, patients will be responsible for facility fees, physician fees and other charges. A facility fee covers the cost of using the emergency room, while a physician fee is linked to the medical care provided by the doctor or other medical professional.

What if I Can’t Afford To Pay My ER Bill?

If a patient cannot afford to pay the full cost of their emergency room visit, they may be able to negotiate a payment plan or apply for financial assistance. Hospitals are bound by law to offer financial assistance programs that provide discounted or free medical care to patients who meet certain income criteria. [4] Any unpaid medical bills will be sent to collections. Your credit may be dinged and in severe cases, you may have to declare bankruptcy.

It is also important to note that there are laws in place to protect patients from excessive medical bills.

For example, hospitals are required to provide an estimate of the cost of services before providing them. [5] This allows patients to save money by refusing services that they believe to be nonessential.

Keep in mind that emergency rooms are federally mandated under the Emergency Medical Treatment and Labor Act (EMTALA) to provide emergency medical services to anyone regardless of their insurance status . [6]

When a patient arrives at the emergency room, the first step is usually triage, which is the process of prioritizing patients based on the severity of their condition. Patients with life-threatening conditions such as severe bleeding or suicidal feelings are given the highest priority.

According to Mira, emergency rooms will file patients into one of five acuity categories depending on their severity. [2]

Those with emergency medical needs will be taken immediately to an exam room where they are evaluated by a physician or nurse practitioner. If the patient’s needs are non-urgent, they may be sent to the waiting room until another exam room opens up. This ensures there are spaces for new patients who require immediate care. If the patient's symptoms are dire, like suffering from head trauma, they’ll be taken to a specialized area like an operating room.

Based on the medical evaluation and tests completed, the medical staff will determine and explain the appropriate course of treatment. This may include medication, procedures such as stitching a wound or draining an abscess or surgery.

How Does ER Billing Work?

When a patient visits the emergency room, they can receive services from multiple providers, including the hospital, the physician and any specialists involved in their care. You can break down the various costs from each by triage fees, facility fees, professional fees and supplies. The triage fee can be anywhere between $200 to $1,000. [2]

The second bill that the patient will receive is the facility fee in order to help cover the costs of running the physical building. The average facility fee in 2021 was $713. [7]

The professional fee is next, with the average cost in 2021 being $321. [7] Note that each professional gives a quote for their services and may include radiologists, pathologists and more. [8]

You will also be charged for any supplies used to treat you including syringes, laryngoscopes and laparoscopes, as well as durable medical equipment (DME) like braces or splints.

If you were transported via a ground ambulance service, you can expect to pay $1,277, on average, for that service. [9]

Your health insurance policy covers ER visits as part of its standard benefits up to a certain amount. Also, insurance companies cannot charge you more for getting emergency services from an out-of-network provider or facility. [10] You can see how much your out-of-pocket cost will be on your health insurance card. The average emergency room cost with insurance in 2020 was $1,150. [11]

However, the amount of coverage may vary depending on the type of plan such as whether you have an HMO or PPO policy.

Your insurance company will have a negotiated rate with a healthcare provider or facility for how much your carrier will spend on a specific type of care.

Any costs that exceed this negotiated rate will usually need to be paid by you out of pocket.

ER visits can be expensive but there are several ways to save money and reduce the cost of an emergency room visit. Here are some tips to lessen the blow to your pocketbook:

• Know your insurance coverage: This includes your copays, coinsurance and deductibles . Once you have this information, you can make an informed decision as to when it’s best to spend your money.
• Consider an urgent care facility or telemedicine: While ERs are staffed 24/7, not all medical situations require a visit to the emergency room. [12] In cases of minor illnesses or injuries, patients may be able to receive cheaper treatment at an urgent care clinic, their primary care physician's office or via virtual appointment
• Use community health clinics: These clinics can provide treatment for minor injuries and illnesses and can help avoid the higher cost of an ER visit.
• Negotiate your bill: Many hospitals have financial assistance programs that can provide discounted or free medical care to patients who meet certain income criteria.
• Regularly receive preventive care: Be sure to include regular check-ups, screenings and vaccinations that can help prevent serious health conditions and avoid costly ER visits.
• Be prepared: Bring your insurance card, a list of current medications and a description of your medical history. Doing so may cut down on any labs or tests they may otherwise run, saving you some money.

If you want coverage for an ER visit but don’t have it, there are several ways to purchase health insurance :

• Individual or group health insurance plan: You can enroll in a plan through your employer, through the health insurance marketplace or directly from an insurance company. Most states hold open enrollment for health insurance from November 1 through January 15. Once you have a health insurance plan, you will be covered for emergency medical conditions, including those requiring an ER visit.
• Medicare: This is typically meant for the elderly. Medicare open enrollment begins October 15th and goes through December 7th every year with coverage beginning January 1st.
• Medicaid: This coverage provides health insurance for people who meet certain income requirements. Medicaid covers conditions requiring an ER visit.
• Children's Health Insurance Program (CHIP): Children in families who earn too much to qualify for Medicaid but cannot afford private health insurance may qualify for coverage. CHIP covers emergency medical conditions.
• Short-term health insurance: Coverage periods are typically less than 12 months. [13] These plans can be more affordable than traditional health insurance plans, but they may have limited coverage for pre-existing conditions and may not cover all medical services, including some emergency medical conditions.
• Continuation of Health Coverage COBRA: This allows you to continue your employer-sponsored health insurance plan for a limited time if you recently lost your job. COBRA coverage can be expensive but it can provide coverage for emergency medical conditions, including those requiring an ER visit.

Does health insurance always cover emergency room visits?

Your health insurance will cover emergency room visits regardless of where you are. However, some health plans may specify that you go to one of their in-network facilities if it is feasible to do so.

Does Medicare cover emergency room visits?

Medicare Part B will pay for emergency room visits. You will have a copay and when you meet your Part B deductible, you will pay an additional 20% for your doctor’s services. [14]

What’s the difference between emergency rooms and urgent care?

Emergency rooms treat serious and life-threatening conditions, while urgent care centers treat less severe issues and often carry shorter wait times and lower costs.

What happens if you go to the ER without insurance?

Emergency rooms are required to give you medical care if it is needed even if you don't have insurance. If you require immediate medical care, call 9-1-1 and they will take you to the nearest emergency room.

What is the average cost of an emergency room visit with insurance?

The average cost of an emergency room visit in 2020 was $1,150. The cost will vary depending on the type of plan, such as whether you have an HMO or PPO .

• UnitedHealthcare. “ What Are My Care Options and Their Costs? ” Accessed March 29, 2023. 
• Mira. “ Emergency Room Visit Cost Without Insurance in 2023 .” Accessed March 29, 2023.
• Sidecar Health. “ Cost of Heart Attack in California .” Accessed March 29, 2023.
• Internal Revenue Service. “ Financial Assistance Policy and Emergency Medical Care Policy – Section 501(R)(4) .” Accessed March 29, 2023.
• A+ Urgent Care. “ No Surprises Act. ” March 29, 2023.
• American College of Emergency Physicians. “ Understanding EMTALA .” Accessed March 29, 2023.
• Peterson-Kaiser Family Foundation. “ How Do Facility Fees Contribute to Rising Emergency Department Costs? ” Accessed March 29, 2023.
• Advance ER. “ Understanding ER Billing .” Accessed March 29, 2023.
• White Paper. “ Ground Ambulance Services in The United States ,” Page 2. Accessed March 29, 2023.
• HealthCare.gov. “ Using Your Health Insurance Coverage. ” Accessed March 29, 2023.
• Consumer Health Ratings. “ How Much Does an ER Visit Cost? ” Accessed March 29, 2023.
• Frontline ER. “ Are Emergency Rooms Open on Weekends? ” Accessed March 29, 2023.
• Kaiser Family Foundation. “ Understanding Short-Term Limited Duration Health Insurance .” Accessed March 29, 2023.
• Medicare.gov. “ Emergency Department Services .” Accessed March 29, 2023.
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• How Much Is An Er Visit Without Insurance

Derek is a former staff writer and has written 100+ articles on property & casualty, health and life insurance topics as an insurance expert for SmartFinancial. Within his decade-long career writing about finances, entertainment, religion and philosophy, Derek spent three years writing financial articles for credit unions throughout the U.S. He prides himself on his ability to translate complex topics into actionable tips for everyday people.

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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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How much does an Emergency Room visit cost without Insurance?

Updated June 3, 2023 by Holly Patiño Leave a Comment

This post may contain affiliate links, which means if you enroll through my link, I’ll receive a small commission at no extra cost to you.

Many people in the United States don’t have health insurance. However, that doesn’t mean that they don’t have to go to the emergency room because of a medical emergency. So, how much should you expect an emergency room visit to cost without insurance?

It costs about $2,200 for an emergency room visit if the patient is uninsured. Costs will vary depending on the emergency type and the severity of the injury or illness. Many hospitals offer payment plans for uninsured patients. Some hospitals provide financial assistance for these patients.

Emergency hospital visits are not something that anyone plans on, and the expenses are even less expected. This can leave individuals in a really difficult financial situation, especially when they are not insured. Keep reading to learn about the cost of an emergency room visit when uninsured, financial assistance, when to seek medical help, and even some alternatives to emergency room visits.

Emergency Type And Severity Will Determine Costs for Uninsured

The average cost of an emergency room visit without insurance is about $2,200 , but emergency room visits can cost as little as $150 or as much as $3,000 . If you’re admitted to the emergency room and you are insured, this cost is significantly reduced to about $50 to $150. However, if you do not have health insurance, you can expect to pay hundreds or even thousands of dollars for medical treatment.

The more severe your injuries or illness are when you go to the emergency room, the more the visit will cost. When you get to the emergency room, you will be put into a category based on your symptoms or injuries: low, moderate, high, and critical.

Low($150-$220): This level is when the condition isn’t serious and the emergency room can handle it without specialists or extensive treatment.

• Cuts and bruises : Cuts and bruises that can be easily bandaged and healed with proper ointments.
• Colds and flu : Sore throat, stuffy nose, and minor coughs.
• Sprains and strains : Sprains and strains can be healed through rest, compression, and ice.
• Inflammation of hairs/skin: Folliculitis and cellulitis are conditions that can be healed with proper cream and ointments.

Moderate ($400-$610): This level may require a diagnosis or treatment for the patient done by an ER doctor but remains low enough that no further action is required as long as it is treated quickly and properly.

• Asthma attacks : Must be treated immediately to offset other serious health issues. It can be treated within a few minutes to hours.
• Infections: Urinary and ear infections can cause discomfort and fever.
• Second-degree burns : Second-degree burns are burns that scar the deeper layers of the skin. there are two types: superficial and deep partial-thickness burns.
• Allergic reactions: Allergies come in many forms such as hives, swelling, and difficulty breathing. Severe allergic reactions are often categorized as moderate by emergency room nurses.

High ($1,000-$1,400): At this level, multiple diagnoses and/or treatments are implemented when the previously mentioned conditions and others are not treated immediately. Conditions and injuries that fall into this range may require a full team of nurses and Emergency Room doctors to work on the patient.

• Extreme pain: Any pain that cannot be reduced regardless of the effects of over-the-counter medications.
• Fractures and dislocations: Fractures and dislocations are non-life-threatening as long as they don’t pierce any vital organs, but they are considered highly important by emergency room nurses.
• Dehydration: If oral rehydration methods do not work, dehydration is dangerous and requires other solutions. If not treated quickly dehydration can lead to shock, organ failure, and death.

Critical (~$20,000): This level means that the patient must undergo critical care procedures (multiple diagnoses and treatments and potential transfer to another facility) and may require immediate surgical interference.

• Heart attacks : This issue involves circulatory complications due to the blood flow to the heart being blocked, resulting in heart attacks or other related issues. CPR and resuscitation methods will be used to attempt to revive the patient along with defibrillators and drugs.
• Aortic rupture : An aortic rupture is a rupture in one of the four aortic valves found in the human heart. This causes a massive amount of internal breathing and is fatal unless treated as soon as possible.
• Poisoning: Ingesting or inhaling toxic substances found in cleaning products, lead, plants, animals, and medications. If you have carbon monoxide poisoning, you will likely be considered critical when you get to the emergency room.
• Strokes : Much like heart attacks, if you have a stroke, blood flow to the brain is blocked, resulting in brain damage.

These levels can also be known as triage , as it helps emergency room nurses identify the conditions of the patients effectively. Other designations for medical conditions can be labeled “non-urgent”, “semi-urgent”, or “urgent”. Another can be forms of ER codes. Codes such as 99281 (straightforward: level 1), 99281 (low: level 2), 99283 (moderate: level 3), 99284 (moderate to high: level 4), and 99285 (high: level 5) provide further details of the complexity of the condition and what actions are to be considered.

These are only the base costs. This does not include any additional fees such as a doctor’s fee, ER occupancy fee, tests and diagnostics, and other services rendered. It also does not account for the location of the facility, as emergency rooms in large cities tend to charge more than emergency rooms in small cities.

Can Hospitals Provide You with Financial Assistance?

In nearly all cases, uninsured patients cannot afford to pay their emergency room medical bills because they are too high to pay out-of-pocket. Because of this, some hospitals are willing to work with uninsured patients and provide financial assistance.

This financial assistance from hospitals will often come in the form of discounts, payment plans, or free or reduced-cost medical services. Payment plans will allow you to spread a large one-time payment into smaller monthly payments. For those in a vulnerable financial position, you may qualify for reduced or waived medical bills depending on where you live and how much money you earn yearly.

Some financial assistance from hospitals may involve helping uninsured patients find a program that can help them pay their medical bills and potentially get free or cheap health insurance in the future.

What To Do If You Do Not Have Health Insurance

Navigating yourself out of a medically uninsured situation does not have to be a tedious task. There are plenty of people in the United States that do not have complete coverage under their medical insurance, and some people have no insurance coverage at all. Instead of worrying about this, you can find alternatives to compensate for this insurance status easier than you might think.

Here are some solutions that can help you receive low-cost emergency medical care.

Find Low-Cost or Free Healthcare Clinics

Not all healthcare clinics cost a fortune. It is possible to find ones that are low-cost or even ones that offer free services. While you might not want to be price-browsing during a medical emergency, as long as you prepare for a medical emergency, there is a good chance that you can find a hospital or clinic near you that meets your budget. However, if you or someone around you is having a medical emergency and a cheap medical facility is far away, it is best to go to a closer emergency medical care facility instead.

Search for free or low-cost healthcare clinics online search or by word-of-mouth.

Negotiate with Providers

Much like working with hospitals themselves, you can work with any medical provider to settle on costs. When receiving treatment see if they can provide generic medicines or tests. While it might not seem like it helped a lot when looking at your emergency room visit bill, you are going to be glad that you were able to save a couple of dollars here and there.

After you receive your bill, you might be able to negotiate the cost with the facility that administered care as long as you tell them that you are uninsured.

Check for Assistance Eligibility

There are many assistance programs that you can be eligible for if you make an effort to check their eligibility. This can relate to purchasing health insurance on the marketplace in that if eligibility requirements are met, you can find options that do not require payment. These eligibility programs may cover just as much as health insurance would and are likely much cheaper for you to use.

Drive to the Emergency Room

One easy way to save yourself some money on an emergency room visit if you do not have health insurance is to drive to the emergency room yourself instead of using an ambulance. Earlier, we talked about how an emergency room visit can cost you over $2,000. If you are driven to the hospital via ambulance, you can expect to pay another $1000 to $2000 out-of-pocket.

If you or someone else has a serious but non-threatening injury, you can save yourself hundreds or even thousands of dollars by going directly to the emergency room yourself. However, you should exercise your best judgment when deciding whether or not to drive yourself to the emergency room.

If someone has a critical injury, they will benefit from being driven to the emergency room via ambulance, and the EMTs in the ambulance may even save their life. If you are injured in a way that limits your vision, mental focus, or ability to drive safely, it is better to use an ambulance.

What Are Some Emergency Room Alternatives?

It is important to note that emergency rooms are not the same as urgent care facilities. However, that does not mean you should not consider going to urgent care if an emergency room visit is not financially feasible.

Urgent care centers are for the immediate treatment of patients that cannot wait for a day or two. Urgent care patients are sometimes transferred to emergency rooms because of the severity of the injury or illness of the patients.

Emergency rooms, on the other hand, operate similarly to urgent care, however, they provide more resources for a medical professional’s needs. They evaluate and then treat the patient according to the situation. These are typically the aftermath of urgent care situations.

The cost of an urgent care center visit is lower than an emergency room visit for both insured and uninsured patients. Uninsured patients will be charged somewhere between $150-$200 for this kind of visit. Urgent care centers also are typically open longer than doctor’s offices. Emergency rooms are typically open 24/7, which means that they are open longer than urgent care centers.

When to Seek Medical Help

If you have the following injuries or symptoms, go to the emergency room even if you are uninsured.

• If you or someone else is struggling to breathe.
• If there is excessive bleeding.
• If there is a large, deep cut that will need stitches.
• If there are serious burns on the skin.
• If there is a head injury.
• If someone is in an unbearable or excessive amount of pain.

Going to the emergency room tends to be about 12 times more expensive than a routine doctor’s visit. To help keep you from spending money you may not have when you’re uninsured, it’s best to detect early signs of potential health issues before it is too late so you can go to the doctor rather than the emergency room.

If there is a sudden or life-threatening health condition, it is best to get treatment at an emergency room and worry about money later. You will likely be able to pay for your emergency room visit in installments that are relatively affordable for you and your family.

Overall, it costs a lot of money to go to the emergency room, especially if you don’t have health insurance. Luckily, if you have a medical emergency and don’t have health insurance, there are things that you can do to lower the cost of your emergency room visit, and you can visit emergency medical facilities that are free or extremely cheap.

No Insurance? 

When it comes to your healthcare, most people think that their only options are to pay for expensive Health Insurance or try out your luck being uninsured.

The great news is that you have a third option; You can join a Health Share plan that is affordable and meets your needs! Health Sharing programs are one of the most effective and affordable alternatives to Health Insurance. 

If you don’t know what a Health Share is, you can start here to learn how it works and why it’s a great alternative to health insurance. If you are looking for affordable healthcare, I highly recommend checking out my article about the Best Health Share Plans . 

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About medical services in Moscow

Moscow polyclinic

Emergency medical care is provided free to all foreign nationals in case of life-threatening conditions that require immediate medical treatment. You will be given first aid and emergency surgery when necessary in all public health care facilities. Any further treatment will be free only to people with a Compulsory Medical Insurance, or you will need to pay for medical services. Public health care is provided in federal and local care facilities. These include 1. Urban polyclinics with specialists in different areas that offer general medical care. 2. Ambulatory and hospitals that provide a full range of services, including emergency care. 3. Emergency stations opened 24 hours a day, can be visited in a case of a non-life-threatening injury. It is often hard to find English-speaking staff in state facilities, except the largest city hospitals, so you will need a Russian-speaking interpreter to accompany your visit to a free doctor or hospital. If medical assistance is required, the insurance company should be contacted before visiting a medical facility for treatment, except emergency cases. Make sure that you have enough money to pay any necessary fees that may be charged.

Insurance in Russia

Travelers need to arrange private travel insurance before the journey. You would need the insurance when applying for the Russian visa. If you arrange the insurance outside Russia, it is important to make sure the insurer is licensed in Russia. Only licensed companies may be accepted under Russian law. Holders of a temporary residence permit or permanent residence permit (valid for three and five years respectively) should apply for «Compulsory Medical Policy». It covers state healthcare only. An employer usually deals with this. The issued health card is shown whenever medical attention is required. Compulsory Medical Policyholders can get basic health care, such as emergencies, consultations with doctors, necessary scans and tests free. For more complex healthcare every person (both Russian and foreign nationals) must pay extra, or take out additional medical insurance. Clearly, you will have to be prepared to wait in a queue to see a specialist in a public health care facility (Compulsory Medical Policyholders can set an appointment using EMIAS site or ATM). In case you are a UK citizen, free, limited medical treatment in state hospitals will be provided as a part of a reciprocal agreement between Russia and UK.

Some of the major Russian insurance companies are:

Ingosstrakh , Allianz , Reso , Sogaz , AlfaStrakhovanie . We recommend to avoid  Rosgosstrakh company due to high volume of denials.

Moscow pharmacies

A.v.e pharmacy in Moscow

Pharmacies can be found in many places around the city, many of them work 24 hours a day. Pharmaceutical kiosks operate in almost every big supermarket. However, only few have English-speaking staff, so it is advised that you know the generic (chemical) name of the medicines you think you are going to need. Many medications can be purchased here over the counter that would only be available by prescription in your home country.

Dental care in Moscow

Dentamix clinic in Moscow

Dental care is usually paid separately by both Russian and expatriate patients, and fees are often quite high. Dentists are well trained and educated. In most places, dental care is available 24 hours a day.

Moscow clinics

«OAO Medicina» clinic

It is standard practice for expats to visit private clinics and hospitals for check-ups, routine health care, and dental care, and only use public services in case of an emergency. Insurance companies can usually provide details of clinics and hospitals in the area speak English (or the language required) and would be the best to use. Investigate whether there are any emergency services or numbers, or any requirements to register with them. Providing copies of medical records is also advised.

Moscow hosts some Western medical clinics that can look after all of your family’s health needs. While most Russian state hospitals are not up to Western standards, Russian doctors are very good.

Some of the main Moscow private medical clinics are:

American Medical Center, European Medical Center , Intermed Center American Clinic ,  Medsi , Atlas Medical Center , OAO Medicina .

Several Russian hospitals in Moscow have special arrangements with GlavUPDK (foreign diplomatic corps administration in Moscow) and accept foreigners for checkups and treatments at more moderate prices that the Western medical clinics.

Medical emergency in Moscow

Moscow ambulance vehicle

In a case of a medical emergency, dial 112 and ask for the ambulance service (skoraya pomoshch). Staff on these lines most certainly will speak English, still it is always better to ask a Russian speaker to explain the problem and the exact location.

Ambulances come with a doctor and, depending on the case, immediate first aid treatment may be provided. If necessary, the patient is taken to the nearest emergency room or hospital, or to a private hospital if the holder’s insurance policy requires it.

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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.

Related Content:

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Medical debt among new mothers

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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What Is Medicare Supplement Plan N?

M edicare Supplement Plan N is a private insurance plan to cover the out-of-pocket costs of Original Medicare. Plan N charges lower monthly premiums than most other Medicare Supplement plans. While Plan N has copayments, they are fixed and not based on the cost of your care. Plan N combines affordability with cost predictability.

Key Takeaways

• Plan N is the third most popular Medigap plan with beneficiaries and one of the least expensive plans.
• Plan N helps to cover your portion of Medicare out-of-pocket costs. 
• Plan N does charge copayments in some situations; it won’t pay 100% of your bills.
• The copayments are fixed between $20 and $50 and are not based on the cost of your care.

How Plan N Works 

Like other Medicare supplement plans, you buy a Plan N Medigap plan from a private insurer. Plan N was the third most popular Medicare supplement choice for Medicare recipients behind Plan G and Plan F, with more than 1.3 million enrollees in 2021 (excluding California), according to a 2023 report from the Congressional Research Service. 

Every month, you pay a monthly premium to the insurer to stay enrolled in the Medigap plan. Plan N has some of the lowest monthly premiums among all Medicare supplement plans other than High-Deductible Plan G, although pricing can differ by insurer. 

No matter which insurer you buy the plan from, Plan N has the same required, standardized basic benefits.

Medicare Part A: 

• Coinsurance or copayments (up to limits outlined below)
• Hospital costs up to an extra 365 days after using up Medicare benefits 
• Entire Part A deductible
• Copayments from day 21 to 100 for post-hospital skilled nursing facility care
• First three pints of blood every year as a hospital inpatient

Medicare Part B:

• Doctor’s office coinsurance or copayments (up to limits below)
• First three pints of blood every year as a hospital outpatient

In addition, Medicare Supplement Plan N covers 80% of foreign emergency care charges during your first 60 days outside the United States, with a lifetime maximum benefit of $50,000. You must first meet the $250 calendar year deductible. 

But Medigap doesn’t cover all the gaps. To get dental, vision, and hearing services and devices, you must sign up for a Medicare Advantage plan . 

Plan N Doctor’s Office Copayments: How They Work

Medicare Part A and B typically feature coinsurance requirements —for example, you’ll be asked to pay 20% of the cost of a doctor’s visit. Plan N steps in to pay most of this fee and only requires a smaller copay for office visits and emergency room visits. In both cases, you must meet the necessary deductibles (meaning you’ll pay bills in full out of pocket) before you’re only obliged to contribute your copayments.

With Plan N, you’ll pay $20 or less for each office visit. Office visits include covered healthcare provider and medical specialist visits. You'll have a copay for each visit if you have multiple office visits in one day. 

“Office visits” include office consultations or evaluation and management visits. For example:  

• New patient visits
• Established patient office or outpatient visits 
• Ophthalmology visits
• Psychotherapy visits

The copay doesn’t apply to X-ray, laboratory, or durable medical equipment charges. 

Plan N Emergency Room Copayments: How They Work

You’ll pay $50 or less for each covered emergency room visit if you’re not admitted to the hospital. You don’t pay a separate physician copay, according to CMS guidance. An urgent care visit doesn’t count as an emergency room visit. 

If you are admitted to the hospital, and the emergency visit is wrapped into a Medicare Part A expense, you don’t pay the copay. Emergency room visits have a higher copayment to “discourage unnecessary emergency room visits,” according to CMS. 

Plan N vs. Plan G

Plan G and Plan N are similar in most ways. Both pay for foreign-based emergency care, skilled nursing facility care copayments, and the entire Part A deductible. Neither pay the Part B deductible. 

However, Plan N’s premiums tend to be lower than Plan G’s. Plan G also offers a high-deductible option that lowers the monthly premiums—premiums are typically under $100 a month—but you’ll first need to hit a $2,800 deductible before your High-Deductible Plan G plan covers costs. 

In addition, Plan G covers the Part B excess charges from medical providers above Medicare’s approved amount, while Plan N does not. Plan G covers all doctor’s office and emergency room visit costs after you meet the deductible. But with Plan N, you’ll pay $20 for doctor’s office visits and $50 for emergency room visits after meeting the deductible. 

Pros & Cons of Plan N

Plan N is one of the more affordable Medicare Supplement plans. While Plan N charges copayments, the costs are fixed. Other low-premium plans, like Plan K and Plan L, charge a percentage of your total medical bill, so your out-of-pocket cost could end up much higher than with Plan N. Plan N also helps pay for emergency travel costs and other gaps in your medical coverage.

On the other hand, Plan N still charges copayments. Other Medicare Supplement plans, like Plan C, Plan F, and Plan G, do not. Plan N doesn’t offer a high-deductible version. Plan N also doesn’t cover your vision, dental, and hearing expenses, even preventive ones—for those, you’ll likely need a Medicare Advantage plan. 

Requirements for Plan N

To qualify for Plan N, you usually must be:

• Turning 65 on or after Jan. 1, 2020
• Enrolled in Original Medicare (not Medicare Advantage) Parts A and B
• In the initial enrollment period for Medicare at age 65
• In 33 states, people who qualify for Medicare due to a disability can be eligible for Plan N or other Medicare supplement policies.

The best time to enroll is during the six-month initial enrollment period for new Medicare beneficiaries. During this period, insurers can’t turn you away for preexisting health conditions, refuse to sell you a Medigap policy, or charge more based on your health history. States also regulate Medigap plans. In some states, Medigap guaranteed enrollment is extended beyond this period.

As long as you stay enrolled and pay the premium, the insurer can’t cancel your Medigap Plan N. 

If you qualify for Plan N, you’ll pay monthly premiums to buy the plan from the insurance company. Generally, you can expect an increase in the plan premium every year. 

Frequently Asked Questions (FAQs)

Does Medicare Plan N Cover Dental?

No, Medicare Plan N does not cover dental as a standard benefit. It is possible that the company you buy your Medicare plan from offers additional dental coverage in some form. However, most preventive senior dental coverage is provided through Medicare Advantage plans. 

What Are the Disadvantages of Plan N?

Plan N requires a copay with every office and emergency room visit after you’ve met your deductible. In addition, Plan N doesn’t cover Part B excess charges and doesn’t offer a high-deductible plan version, which can reduce monthly premiums. If you try to buy Plan N outside your initial Medicare enrollment period, the insurer could charge you a higher premium based on your health. 

The Bottom Line

Medicare Supplement Plan N is an affordable way to handle the Original Medicare coverage gaps. Insurers typically charge lower premiums for Plan N versus other Medicare Supplement plans. One drawback is that Plan N charges copayments, but these copayments are fixed and not based on the cost of your medical care. An insurance broker can help you estimate your total costs using Plan N versus your other Medicare insurance options.

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AMA indicates against medical advice; EC3, Emergency Critical Care Center; and ED, emergency department.

eTable 1. Pre– and Post–ED-ICU Financial Metrics for All Patients Presenting to ED Adjusted for Inflation, Charlson Comorbidity Index (CCI), and Emergency Severity Index (ESI)

eTable 2. Pre– and Post–ED-ICU Financial Metrics Comparison of ESI 4 and 5 vs Critically Ill Patients (Admitted to ICU or EC3)

eTable 3. Pre– and Post–ED-ICU Cohort Comparison RVUs per Visit and RVUs per Attending Hours

• The Perspective of Value in Caring for Critically Ill Patients JAMA Network Open Invited Commentary September 28, 2022 Evie Marcolini, MD; Brian T. Wessman, MD

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Bassin BS , Haas NL , Sefa N, et al. Cost-effectiveness of an Emergency Department–Based Intensive Care Unit. JAMA Netw Open. 2022;5(9):e2233649. doi:10.1001/jamanetworkopen.2022.33649

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Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

• 1 Division of Critical Care, Department of Emergency Medicine, University of Michigan, Ann Arbor
• 2 Max Harry Weil Institute for Critical Care Research and Innovation, Ann Arbor, Michigan
• 3 Department of Critical Care, Medstar Washington Hospital Center, Washington, DC
• 4 Department of Emergency Medicine and Learning Health Sciences, University of Michigan, Ann Arbor
• 5 Department of Emergency Medicine, University of Michigan, Ann Arbor
• 6 Clinical Financial Planning & Analysis, University of Michigan, Ann Arbor
• Invited Commentary The Perspective of Value in Caring for Critically Ill Patients Evie Marcolini, MD; Brian T. Wessman, MD JAMA Network Open

Question   What is the association of an emergency department–based intensive care unit (ED-ICU) with cost of care delivery?

Findings   In this economic analysis performed at an academic medical center in the US, implementation of an ED-ICU was not associated with a change in inflation-adjusted cost per ED patient encounter.

Meaning   These findings suggest that implementation of an ED-ICU model can provide higher value care by improving quality (reduced ICU use and 30-day mortality) without increasing cost.

Importance   Value in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care.

Objective   To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter.

Design, Setting, and Participants   This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre–ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post–ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021.

Exposures   Implementation of an ED-ICU.

Main Outcomes and Measures   Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED.

Results   A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre–ED-ICU cohort and 119 832 patients (54.5% women) in the post–ED-ICU cohort. The post–ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P  < .001), required more intensive respiratory support (2.2% vs 1.1%; P  < .001) and more vasopressor use (0.5% vs 0.2%; P  < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P  < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre–ED-ICU, mean [SD], $4875 [$15 175]; post–ED-ICU, $4877 [$17 400]; P  = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P  < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P  < .001).

Conclusions and Relevance   Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.

During the last 2 decades, increasing acuity and volume of emergency department (ED) visits have resulted in greater demand for critical care services in the ED and intensive care units (ICUs). 1 , 2 This change has coincided with a shortage of intensivists and resulted in increased boarding of patients requiring critical care in the ED. 1 - 4 Boarding of critically ill patients in the ED is associated with worse patient outcomes. 5 - 8 This association, together with increased need for critical care services, has led to the exploration of various ED critical care delivery models. 9 These models include ED clinicians performing critical care for patients awaiting ICU admission, critical care consult services within EDs, and the ED-ICU model (ED-ICU). 10 - 12 In February 2015, University of Michigan Health opened the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU.

Gunnerson et al 13 previously reported the association of ED-ICU implementation with improved quality as evidenced by improved 30-day survival and reduced inpatient ICU admissions for all patients in the ED. An editorial by Kurz and Hess 14 suggested that without data to determine the value of this model, the feasibility and sustainability of its widespread adoption are largely uncertain. Value in health care is defined as quality per unit cost (V = Q/C). 15 Because the ED-ICU improvement in quality has been described previously, it is essential to determine cost to assess the model’s value. The primary objective of this study was to assess the association of an ED-ICU with changes in the direct cost of care delivery (direct costs incurred by the institution to deliver patient care) to the ED and our hospital system as a whole. Additional outcomes included net revenue, net direct margin (net revenue minus cost), and professional billing for ED encounters. We hypothesized that the coordination of early high-intensity care for patients with high-acuity visits in the ED-ICU would improve care, resulting in downstream delivery cost savings to the hospital system.

This is a retrospective economic analysis of the cost of care delivery to patients before and after implementation of the Emergency Critical Care Center, an ED-ICU at an academic medical center in the US. The institutional review board at the University of Michigan reviewed and approved this study, which included a waiver of Health Insurance Portability and Accountability Act authorization. This study retrospectively analyzed data previously collected during the course of routine clinical care and is reported in compliance with the Consolidated Health Economic Evaluation Reporting Standards ( CHEERS ) guideline.

The context and background of clinical operations in the University of Michigan adult ED before and after ED-ICU implementation were discussed previously by Gunnerson et al. 13 Before ED-ICU implementation, all patients requiring ongoing critical care continued to be treated by the ED team in consultation with inpatient ICU teams. This care was continued until an inpatient ICU bed became available or the patient no longer required critical care and was admitted to a non-ICU level of care. After ED-ICU implementation, patients requiring ongoing critical care could be transferred to the ED-ICU team and cared for in the 9-bed ED-ICU, regardless of inpatient ICU bed availability.

Our hospital system, like most in the US, uses a volume-based costing model rather than prospectively capturing individualized direct patient-level costs of care. We calculated the direct cost of care for every ED patient encounter in each cohort by using the ratio of cost to charges (RCCs) and total charges for that encounter. 16 , 17 Both the pre–ED-ICU and post–ED-ICU direct facility costs were estimated using the RCCs and subsequently adjusted for inflation. By using the same RCC method to derive cost data while adjusting for variables that are known to affect cost, changes in direct facility costs seen between the pre–ED-ICU and post–ED-ICU cohorts are potentially associated with implementation of the unit itself. Facility costs were analyzed given that the focus was on costs at the ED and hospital level.

To test for differences in cost of care delivery before and after ED-ICU implementation, we analyzed data from the electronic health records of all ED visits from September 8, 2012, through April 21, 2017. We excluded July 1, 2014, through June 30, 2015, from analysis to allow for a washout of data over a fiscal year as we transitioned between the 2 models of care being analyzed (the ED-ICU underwent a phased opening between February and May 2015). The pre–ED-ICU cohort included all visits to the ED from September 8, 2012, through June 30, 2014 (660 days), and the post–ED-ICU cohort included all visits to the ED from July 1, 2015, through April 21, 2017 (660 days). The study data included all ED visit–associated accounts in which the patient was 18 years or older at the time of service, was treated by an ED clinician, and had a complete and interpretable financial record for the encounter. Accounts with noninterpretable financial data included accounts that (1) were still open and had a nonzero balance, (2) had no documented charges, (3) combined multiple hospitalizations (eg, index hospitalization was a scheduled procedure followed by an ED visit after discharge), (4) did not include a complete acute care hospitalization record (eg, patients who were transferred to another acute care facility during the course of their hospitalization), or (5) contained conflicts between clinical and financial records that were implausible (eg, billing from incorrect fiscal year). Rates of missing data were low, as outlined in Figure 1 .

Implementation of the ED-ICU, designed to provide rapid initiation of ICU-level care in the ED and to facilitate seamless transition to inpatient ICUs, constituted the study exposure. The primary outcome of this study was the change in inflation-adjusted total direct cost per ED encounter before and after ED-ICU implementation. A subanalysis was performed to determine the direct cost of care attributed to the ED portion compared with the inpatient hospitalization portion of the encounter. Secondary outcomes included change in inflation-adjusted net revenue (payment) per patient encounter before and after ED-ICU implementation and change in inflation-adjusted direct margin (net revenue minus cost) per patient encounter among all patients in the ED before and after ED-ICU implementation.

We used the Emergency Severity Index (ESI) 18 and the Charlson Comorbidity Index (CCI) 19 to adjust the results for disease severity variation between pre–ED-ICU and post–ED-ICU cohorts (eTable 1 in the Supplement ). The ESI represents 5 different levels of anticipated intensity of resource use based on severity of illness at ED presentation. Levels range from ESI 1 (most resource intensive) to ESI 5 (least resource intensive).

A subanalysis was performed of only patients with critical illness, defined as those admitted to the inpatient ICU in the pre–ED-ICU cohort and those transferred to the ED-ICU or admitted to the inpatient ICU in the post–ED-ICU cohort (eTable 2 in the Supplement ), to determine the association of costs among the population most likely to benefit from the intervention. A further subanalysis was performed with a low-acuity subpopulation of patient encounters in the ED defined as ESI 4 and 5. Most patients with ESI 4 and 5 encounters will not require critical care and provide a comparator population that does not use the ED-ICU. This subanalysis was performed to evaluate whether unrelated temporal trends contributed to changes in cost, revenue, and margin rather than the results being associated with the intervention itself.

In addition, the impact of ED-ICU deployment on professional billing fees associated with the measured outcomes for ED encounters was quantified through the analysis of relative value units (RVUs) across the pre–ED-ICU and post–ED-ICU cohorts (eTable 3 in the Supplement ). Relative value units are used to quantify the billing of physician services that can be compared across medical disciplines. 20 We compared RVU per ED encounter across pre–ED-ICU and post–ED-ICU cohorts to determine how overall ED professional billing changed over time and whether any fundamental shifts in billing or coding practices might account for the outcomes observed. In addition, RVU per faculty hour was analyzed to assess the association with increased physician staffing required to run the ED-ICU.

Data from a total of 234 884 ED visits were identified and analyzed. Bivariate linear regression analyses 21 were used to test hypotheses about pre–ED-ICU and post–ED-ICU cohort differences in (1) mean direct cost of the encounter to the hospital and (2) mean direct cost of the encounter to the ED. All cost variables were inflation-adjusted to 2018 dollars. Inflation normalization removes the impact of the inflationary component on pricing. Unlike other sectors, there is no established index for cost of care delivery inflation in the health care industry. A 4% total expense inflation assumption is a common value used for business budgeting in our organization. Personnel (nursing and physician) costs reflect most of the cost increase. Wage and benefit expenses increased 3% per year on average and larger increases were seen in pharmaceutical and other supply expenses. Therefore, 4% was used to normalize or remove the impact of inflationary price changes on the direct costs of care delivery for fiscal years 2013 to 2017.

Cluster-robust SEs were estimated to account for multiple visits clustered within patients. An α < .05 was used for all analyses, and all hypotheses were 2 sided. Analyses were conducted with Stata, version 15 (StataCorp LLC), from March 1 to December 30, 2021.

A total of 234 884 ED visits with 60 848 ED hospital admissions (representing 38 477 unique patients) during the study period were analyzed, with 115 052 patients (54.7% women and 45.1% men) in the pre–ED-ICU cohort and 119 832 (54.5% women and 45.4% men) in the post–ED-ICU cohort ( Table 1 ). Race and ethnicity data were not collected or available for analysis. The mean (SD) age of patients was 47.8 (19.6) years in the pre–ED-ICU cohort and 49.1 (19.9) years in the post–ED-ICU cohort ( P  < .001). The mean (SD) ED length of stay increased from 6.9 (5.1) hours in the pre–ED-ICU cohort to 7.8 (5.6) hours in the post–ED-ICU cohort ( P  < .001) (the ED length of stay is inclusive of ED-ICU length of stay). The admission rate was 25.4% in the pre–ED-ICU cohort and 26.4% in the post–ED-ICU cohort ( P  < .001). The post–ED-ICU cohort had a higher proportion of patients receiving intensive respiratory support (ie, mechanical ventilation, noninvasive ventilation, heated high-flow nasal cannula) (2.2% vs 1.1%; P  < .001) and vasopressor infusion (0.5% vs 0.2%; P  < .001) and higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P  < .001). Despite the increased intensity of resources, the inpatient ICU admission rate was lower (2.5% vs 2.8%; P  < .001) in the post–ED-ICU cohort.

Total direct costs per ED encounter were similar in the pre–ED-ICU (mean [SD], $4875 [$15 175]; median, $1110 [range, $0.01-$1 222 961]; total, $560 573 021) and post–ED-ICU (mean [SD], $4877 [$17 400]; median, $1138 [range, $0.59-$3 279 953]; total, $584 443 676) cohorts (change, 0.04% [95% CI, −2.7% to 2.8%]; P  = .98).There was a statistically significant increase in direct ED cost per ED encounter (mean [SD], $660 [$669] vs $717 [$959]; change, 8.6% [95% CI, 7.6%-9.7%]; P  < .001) and a nonstatistically significant decrease in direct hospital cost per ED encounter (mean [SD], $4216 [$14 997] vs $4161 [$17 187]; change, −1.3% [95% CI, −4.4% to 1.8%]; P  = .44). Net revenue per encounter increased from the pre–ED-ICU to the post–ED-ICU cohorts (mean [SD], $5728 [$20 151] vs $6132 [$28 839]; change, 7.0% [95% CI, 3.5%-10.6%]; P  < .001). Similarly, direct margin per encounter increased (mean [SD], $856 [$10 739] vs $1255 [$14 987]; change, 46.6% [95% CI, 32.1%-61.2%]; P  < .001) ( Table 2 ).

Total direct cost per ED encounter remained unchanged when adjusted for CCI (change, −0.07% [95% CI, −3.6% to 2.3%]; P  = .63) and decreased when adjusted for ESI (change, −4.5% [95% CI, −7.3% to 1.8%]; P  = .001). Total net revenue per case increased when adjusted for both CCI (change, 6.4% [95% CI, 2.5%-10.2%]; P  = .001) and ESI (change, 2.0% [95% CI, −1.6% to 5.7%]; P  = .26). Total direct margin per case also increased when adjusted for both CCI (change, 46.3% [95% CI, 30.5%-62.2%]; P  < .001) and ESI (change, 38.9% [95% CI, 23.9%-54.0%]; P  < .001) (eTable 1 in the Supplement ).

The subanalysis of critically ill patients (9908 [4.2% of total ED encounters]) demonstrated cost savings for this subpopulation, with total direct cost per ED encounter decreasing by 22.1% (95% CI, −26.8% to −17.5%; P  < .001). Total net revenue decreased by 19.5% (95% CI, −25.4% to −13.5%; P  < .001). Because both total direct cost and net revenue decreased, total direct margin had no statistically significant change, but remained positive (mean [SD], $7841 [$47 624] vs $7290 [$36 001]; P  = .52) (eTable 2 in Supplement ).

In a subanalysis of patients with low-acuity visits (ESI 4 and 5) (25 863 [11.0% of total ED encounters]), total direct cost per ED encounter was unchanged between pre–ED-ICU and post–ED-ICU cohorts (mean [SD], $533 [$2085] vs $525 [$1679]; change, −1.5% [95% CI, −10.2% to 7.1%]; P  = .74). However, increases in both total net revenue (mean [SD], $708 [$2116] vs $782 [$2585]; change, 10.4% [95% CI, 1.9%-19.0%]; P  = .01) and total direct margin (mean [SD], $175 [$1377] vs $257 [$1679]; change, 46.9% [95% CI, 19.1%-74.6%]; P  < .001) were found in this population (eTable 2 in the Supplement ).

Analysis of overall RVUs per encounter increased significantly between pre–ED-ICU and post–ED-ICU cohorts when ED-ICU RVUs were included (2.94 vs 3.15; 7.1% increase; P  < .001). The portion attributed to ED-ICU billing was 5.47 RVUs per encounter for ED-ICU encounters only. However, the total did not change significantly across the entire ED population in the pre–ED-ICU– vs post–ED-ICU cohorts when ED-ICU encounters were excluded (2.94 vs 2.96 RVU per encounter). Relative value units per attending hour decreased by 9.4% between the pre–ED-ICU and post–ED-ICU cohorts (6.55 vs 5.94; P  < .001) (eTable 3 in Supplement ).

Implementation of an ED-ICU has previously been associated with improved patient outcomes (15.4% reduction in risk-adjusted 30-day mortality) and use of resources (12.9% reduction in ICU admission). 13 In this study, we demonstrate the inflation-adjusted total direct cost per ED encounter remained unchanged despite an 8.6% increase in direct ED cost per ED encounter. The ability to hold overall cost per ED encounter constant while caring for a patient cohort with higher-acuity, more resource-intensive needs and improving patient outcomes could be attributable to the implementation of the ED-ICU.

The increased direct cost to the ED is not unexpected, because the infrastructure and staff required to operate an ED-ICU and extended critical care provision is resource intensive. The largest portion of these increased costs is secondary to labor with dedicated staffing of nurses, a respiratory therapist, a combination of nontrainee (physician assistants) and trainee (residents and fellows) staffing, and an attending physician 24 hours per day. Physician assistants represent a mean of 28.5% of nonattending ED-ICU staffing, whereas residents and fellows represent the other 71.5%. The ratio of trainee to nontrainee staffing and associated staffing expense is likely to vary based on multiple local and institutional factors. In addition, increased diagnostic testing and therapeutic interventions within the ED-ICU likely increased overall ED costs to deliver care. However, the ED costs per encounter only represented 14.7% of the overall cost per encounter and increased by only a mean of $57 per case ($660 vs $717; P  < .001), whereas the inpatient cost per encounter decreased by a mean of $55 per case ($4216 vs $4161; P  = .44). Improved quality of ED care potentially provided downstream care delivery cost savings and allowed the intervention to maintain overall cost neutrality.

Implementation of an ED-ICU was associated with overall cost reduction per encounter for the subpopulation of patients receiving ICU-level care (22.1%; P  < .001). In contrast, there was no overall cost reduction for low-acuity ED encounters defined as ESI 4 and 5 (1.5%; P  = .74). We hypothesize that these observed findings of reduced costs for critically ill patients are associated with early, coordinated critical care delivery in an ED-ICU when the need is identified, rather than when an ICU bed is available. Prior studies 22 have demonstrated increased morbidity and mortality across disease states for boarding critically ill patients in the ED. By initiating critical care interventions early in the ED-ICU, we hypothesize that progression of disease severity and complications due to delayed ICU-level care during ED boarding were avoided, resulting in improved downstream patient outcomes with associated overall cost reductions.

Analysis of overall RVUs per encounter increased significantly when ED-ICU RVUs were included (2.94 vs 3.15; 7.1% increase; P  < .001). However, this finding is expected because the provision of longitudinal critical care results in additional billing for 99291 and 99292 emergency medicine critical care codes. Patients in the ED-ICU generated a mean of 5.47 RVUs per encounter for ED-ICU encounters. However, total RVUs per encounter did not change significantly across the entire population in the ED in the pre–ED-ICU vs post–ED-ICU cohorts when ED-ICU encounters were excluded (2.94 vs 2.96 RVUs per encounter). This finding suggests that no fundamental shift in our ED billing and coding or documentation practices affected our revenue over time between the 2 cohorts. In addition, we found a significant decrease (−9.4%; P  < .001) in RVUs per attending hour between the pre–ED-ICU and post–ED-ICU cohorts, which illustrates that attending physician hourly billing during ED-ICU staffing was lower than billing during main ED staffing.

This analysis reports the direct ED and hospital system costs associated with a novel care delivery mechanism (the ED-ICU), allowing completion of the value equation when paired with prior quality data ( Figure 2 ). 13 Previous work 23 - 32 has investigated the impact of other novel care delivery mechanisms on component(s) of value in emergency medicine, including telehealth, clinician in triage, split flow, and discharge lounges. The use of telehealth in EDs has been associated with estimated lower total annual ED costs and improved quality via reduced ED length of stay and waiting time. 29 , 32 Conversely, clinician-in-triage models have been associated with improved quality via reduced ED crowding, ED length of stay, and rate of leaving without being seen but also with increased costs to EDs and lack of cost-effectiveness. 23 - 27 Split-flow models and discharge lounges have been linked to improved quality via improved efficiency, reductions in ED length of stay, and reductions in ED crowding, 27 - 31 although to our knowledge, assessments of costs (and thereby value) are lacking. Our findings add to this body of literature by providing costs associated with implementing an ED-ICU to complete the assessment of value. With growing interest in transitioning to high-value health care, 33 - 36 individuals and institutions contemplating implementation of a novel care delivery mechanism should consider available quality and cost data to best guide assessments of potential value added.

Future research should investigate the value the ED-ICU model creates for health care payers, including insurance companies, society, and patients. Conceptually, the reduced need for ICU and inpatient care is likely financially beneficial to payers. However, it is not known whether or how the increased ICU capacity generated by an ED-ICU impacts overall health care payments for an insured population. Although overall net revenue and total direct margin for ED patient care increased in the post–ED-ICU period, it is unclear whether these increases can be attributed directly to ED-ICU implementation. The direct charges for patients ultimately admitted to the ICU decreased (eTable 2 in the Supplement ) in the post–ED-ICU period, whereas margin for this subpopulation was unchanged, suggesting that the source of increased revenue and margin came from the care of ED patients not admitted to the ICU. Although the revenue and margin improvements could be attributed to care of patients in the ED-ICU who were not admitted to an inpatient ICU, they could also be attributed to treatment of non–critically ill patients in the ED in the post–ED-ICU period. In fact, subanalysis of ESI 4 and 5 encounters indicates increased revenue and margin for this patient population in the post–ED-ICU period.

This study has some limitations. As a retrospective study with a before-and-after analysis at a single center, external generalizability is unknown. Before-and-after analyses are limited to assessment of association rather than direct causation, and additional unaccounted confounders (including temporal trends) may impact the observed results. The associated costs, revenue, margin, and sustainability are likely to differ at institutions with different staffing expenses (including those with different ratios of trainees [resident physicians or fellows] vs nontrainees), payer mixes, and inpatient capacity constraints. It is also possible that overuse or unnecessary use of the ED-ICU could lead to increased costs in other settings. Net revenue and total direct margin increased during the study period despite a higher degree of acuity in the post–ED-ICU cohort, as manifested by older age, higher case mix index, and higher rate of requirements for respiratory support or vasopressors, although this may have been confounded by margin attributed to a portion of patients that were not critically ill (eTable 2 in the Supplement ).

Our analysis did not specifically account for construction or planning expenses, although infrastructure depreciation is a part of the expense included in our analysis. This start-up process and associated expenses are likely to vary by institution and local factors (eg, only altering staffing models vs complete design and construction of a new facility), and thus we focused our financial analysis instead on operating expenses once implemented. Those considering implementing an ED-ICU at their institution should consider local circumstances with the expense and revenue data presented in this study.

Our evaluation of cost and its components analyzes the total direct facility costs to the hospital system for pre–ED-ICU and post–ED-ICU cohorts. Direct facility costs constitute a myriad of elements, including labor, pharmaceuticals, and supplies to facilitate patient care. Direct facility costs for the hospital system are driven by the institution’s contracts to support required staffing and other resources. The relatively flat total direct inflation-adjusted ED and hospital costs may reflect effective cost management practices across the health care system and not just those efforts to efficiently manage the ED-ICU. The health care system’s net direct margin is impacted by many elements, including contracting, case management, intensity of service, and payer mix. This financial impact study profiled the overall direct costs and net revenues and did not distinguish between components influencing margin performance. It is possible payer mix changes across measurement periods or other revenue drivers not quantified in this study contributed to the calculated margin performance.

The 4% rate of inflation used in this analysis may be an overestimate or an underestimate of actual health care delivery expense and revenue inflation in the study periods. Although this assumption is based on components of the actual experience of our health system and grounded in the annual budgeting practice of our organization, overadjusting or underadjusting for inflation could have an impact on the net margin calculation for an ED-ICU.

Also, this work is limited by data that were previously collected, although rates of missing data were low (<0.1%). The cost analysis used RCCs, which is an estimation of the cost of care delivery and not the same as more precise activity-based costing systems. This is because our hospital currently does not use activity-based costing for cost analysis, and thus data for such a system were not available. However, because we were primarily performing an analysis at a hospital system level, a macro level that encompasses the global cost of care delivery, RCCs would have a higher level of accuracy.

This evaluation examines the costs and revenues associated with a portion of the care a patient would experience in an ED and hospital for a given episode of illness. The evaluation of an ongoing investment in this model of care should consider variables impacting the total episode cost and net revenue of the patient care encounters across the spectrum of health care services provided.

Previous work demonstrated that an ED-ICU was associated with improved care quality and patient outcomes via reductions in use of the ICU and 30-day mortality. Our economic analysis completes this value assessment by demonstrating that the ED-ICU model can work in tandem with the ED and hospital to provide care in a cost-effective manner. Improving quality while holding overall delivery costs constant can potentially increase the value of health care delivery.

Accepted for Publication: July 30, 2022.

Published: September 28, 2022. doi:10.1001/jamanetworkopen.2022.33649

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Bassin BS et al. JAMA Network Open .

Corresponding Author: Benjamin S. Bassin, MD, Division of Critical Care, Department of Emergency Medicine, Michigan Medicine, B1 354D Taubman Center, 1500 E Medical Center Dr, Ann Arbor, MI 48109 ( [email protected] ).

Author Contributions: Dr Bassin had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bassin, Haas, Peterson, Gunnerson, Maxwell, Laurinec, Havey, Neumar.

Acquisition, analysis, or interpretation of data: Bassin, Haas, Sefa, Medlin, Gunnerson, Maxwell, Cranford, Olis, Loof, Dunn, Burrum, Gegenheimer-Holmes, Neumar.

Drafting of the manuscript: Bassin, Haas, Sefa, Gunnerson, Maxwell, Laurinec, Loof, Burrum.

Critical revision of the manuscript for important intellectual content: Bassin, Haas, Sefa, Medlin, Peterson, Gunnerson, Cranford, Laurinec, Olis, Havey, Dunn, Gegenheimer-Holmes, Neumar.

Statistical analysis: Bassin, Sefa, Cranford, Loof, Dunn, Burrum.

Administrative, technical, or material support: Bassin, Peterson, Maxwell, Laurinec, Olis, Havey, Loof, Dunn, Burrum, Gegenheimer-Holmes, Neumar.

Supervision: Bassin, Peterson, Gunnerson, Neumar.

Conflict of Interest Disclosures: Dr. Bassin reported receiving salary support from the Joyce and Don Massey Family Foundation during the conduct of the study. No other disclosures were reported.

Funding/Support: The Joyce and Don Massey Family Foundation provided support for the Joyce and Don Massey Family Foundation Emergency Critical Care Center.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Robert Hewlett III, MA, and Paul Castillo, BA, (Michigan Medicine) provided support for financial analysis and the overall Emergency Critical Care Center (EC3) concept. Neither were compensated for these contributions. We thank the Joyce and Don Massey Family Foundation for their assistance with the development and ongoing support of the EC3 model and the Max Harry Weil Institute for Critical Care Research and Innovation for supporting the mission of EC3.

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