ER vs Urgent Care Costs: How Billing Works
A plain guide to how hospital emergency room visits are billed by level, how urgent care billing generally differs, and what the No Surprises Act says about emergency services. General information only, not medical advice.
How hospital ER visits are billed by level
Hospital emergency departments bill visits by level. Each visit is assigned a level, and a higher level generally carries a higher facility charge. That level is only one line on a bill. Tests, imaging, supplies, drugs and procedures are typically listed separately.
Hospitals set these charges from their own price lists. For background on where those list prices come from, see our guide to what a chargemaster is. The figure on that list is a gross charge, a sticker price that is not what most payers actually hand over: insurers pay negotiated rates, and many hospitals also offer a discounted cash price. Under the CMS Hospital Price Transparency rule, which has applied since January 1, 2021, each hospital must post a machine-readable file of its standard charges.
What an ER facility charge does and does not include
A hospital or hospital outpatient department can bill a facility fee. Physicians, such as radiologists and anesthesiologists, usually bill a separate professional fee. One visit can therefore produce more than one bill.
The prices on Clear Hospital Costs are hospital facility charges taken from the hospitals' own files. They are not total costs. Our guide to facility fees versus professional fees explains the difference in more detail.
How urgent care billing generally differs
Urgent care centers are separate businesses from hospital emergency departments, and they organize their billing in their own way. Practices vary from one center to the next. Some centers are owned by or affiliated with hospitals, which can change how a visit is billed.
Clear Hospital Costs shows hospital ER visit facility charges. It does not show urgent care prices, so this page cannot compare the two. A center can be asked directly how it bills and whether it offers a self-pay rate. Our guide on how to ask for the self-pay price includes ideas for that conversation.
What the No Surprises Act says about emergency services
The No Surprises Act took effect on January 1, 2022. For people with most private health plans, it generally protects against surprise bills for emergency services, including care at out-of-network facilities. For those services, what a patient owes in cost sharing is generally held to the amounts that would apply in-network.
The law also generally covers certain non-emergency services from out-of-network providers at in-network hospitals and ambulatory surgical centers. Ground ambulance rides fall outside these protections. Whether a particular bill falls under the law depends on the plan and the circumstances, so questions can go to an insurer or the CMS No Surprises help desk.
In a medical emergency, call 911 or go to the nearest emergency room. This site does not advise on where to seek care.
Good faith estimates and scheduled care
Emergency visits are not scheduled in advance, but some other services are. In CMS terms, a shoppable service is one a patient is able to schedule ahead of time. The No Surprises Act lets people who are uninsured, or who decide not to run a service through their insurance, request a good faith estimate of what scheduled items and services are expected to cost. A provider has to supply one if the service is booked at least 3 business days out, and also whenever a patient asks.
Suppose the final bill from a provider or facility ends up at least $400 above its good faith estimate. In that case the patient may be able to turn to the patient-provider dispute resolution process, which in general has to be begun within 120 calendar days of the bill date. Our guide to the good faith estimate and the No Surprises Act covers the steps.
Reading the bill after a visit
Hospital bills often list revenue codes for the department or type of service, along with CPT or HCPCS codes for specific items. The American Medical Association maintains CPT codes, which are made up of five characters. CMS maintains HCPCS Level II codes, which reach items such as supplies, drugs and some services.
An itemized version of a bill can be requested and compared line by line. These guides may help:
Options if a bill feels out of reach
Some people ask the hospital about financial assistance. Nonprofit (tax-exempt) hospitals must meet IRS section 501(r) requirements. These include a widely publicized written financial assistance policy and limits on what eligible patients are charged for emergency and other medically necessary care, generally no more than the amounts billed to insured patients. Eligibility rules are set hospital by hospital, and assistance is not limited to nonprofits, since many other hospitals offer it too, on terms that differ. See our guide to hospital financial assistance.
Others ask for a billing review or a payment plan. Our guide to negotiating a hospital bill describes some of those options. With a high-deductible plan, a member often pays the plan's negotiated rate for a service until the deductible is met. Our high-deductible plan tips cover more.
Finding hospital ER prices on this site
Clear Hospital Costs publishes hospital prices for Texas, Florida and Tennessee, refreshed from the hospitals' files twice a week. For each hospital, the site lays out gross charges, cash prices and insurer negotiated rates. Start at the Texas hub or the Florida hub. To see how the data is handled, including how clear errors are left out, read our methodology.
General information only, not medical, legal or insurance advice. Rules change and individual situations differ; for your own bill or plan, contact the hospital, your insurer, or the CMS No Surprises help desk. See our disclaimer and methodology.