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Hospital clinic and office visit charges and medicare payments 2020.

Find Hospital Clinic and Office Visit charges (average price) for 2020, and the payments that Medicare made. Find average charges for about 13,000 different codes (depending whether office or hospital facility-based). National average prices are in a large dataset file. Extremely difficult to use, even if somewhat familiar with using Excel files. File uses HCPCS codes. The most common codes were office visits 99213 (average charge about $149) and 99214 (average charge about $222). Medicare allowed about $72 for code 99213 and about $105 for 99214. Therapeutic exercise (code 97110) had average charge of $63, with Medicare allowing about $26. Lab tests, x-ray, emergency department visits are in the file. An Emergency Department visit (code 99285) had a national average facility charge of $1,201, with Medicare allowing just $174 for the ER visit facility charge. A CBC lab test 85025 had an average charge of $35 (Medicare allowed $8); a blood test coded 88053 had an average charge of $56, with Medicare allowing $10. State by state average prices are also listed. Physician charges may be available in the Provider dataset. Calendar year 2020 data from CMS updated July 2022.

Average Cost of a Hospital ER Visit, MEPS

What is the average cost of a hospital ER visit?  According to the Medical Expenditure Panel Survey (MEPS), the average cost of an ER visit was $1,150 in 2020, up 6.3% from 2019. (If you add medical inflation to 2022, the ER cost estimate would be about $1,210.) Adults ages 18 to 64 had the highest average visit cost at $1,385. Infants and children under age 18 cost $821 per visit on average. Age 65+ averaged $849. The average ER visit cost for someone uninsured was about $1,500 in 2020, up 23% compared to a year earlier. Someone under age 65 with private insurance had an average ER visit expense of $1,682. Many people made more than one trip to the Emergency Room in 2020. Consequently, the total expenditure per person with one or more ER visits during the year, was $1,724 in 2020. The median expenditure per person with an expense was $852.

The costs reported by MEPS are the expenditures (total amounts paid by all parties including insurance) for the ER visits. Actual charges would be much higher. An older, but detailed explanation – using cost to charge ratios – was published in December 2020 ( HCUP Statistical Brief #268 ). It reports an average cost (different methodology) for an Emergency Department visit in 2017 of only $530 (which would be about $609 in 2022 dollars). The federal government has not released costs for the 2021 Emergency Department visits yet. The interactive tool may be difficult for many people to use.

California – Average Inpatient and Outpatient Prices, 2022 Hospital Chargemaster

California provides average prices for inpatient and outpatient procedures as of June 1, 2022, as listed in each hospital’s chargemaster. All CA hospitals are included. Excel files show prices for at least 25 common outpatient procedures. ER visits, MRI and CT test prices should be included, along with selected outpatient surgery. The average cost (charge) for top 25 types of outpatient procedures or surgery includes CPT codes. Outpatient reports may show hospital prices for Emergency Room visits, office visit code 99213, lab tests, CT, MRI, Mammogram, x-ray, ultrasound, Physical Therapy visit, Arthroscopy, colonoscopy, endoscopy, carpal tunnel, hernia repair, gall bladder removal (laparoscopic cholecystectomy), lumbar injections, tonsillectomy, ear tubes and more, depending on each hospital’s highest volume.

California 2022 inpatient prices are listed only in each hospital’s massive and complicated Charge Master, which shows the charge for every pill, lab test and hospital room rate. This is where you will find maternity, obstetrics, newborn nursery, labor and delivery charges. But you may need to wade through more than 10,000 individual services listed in the chargemaster to find what you want to know.  Files are in Excel file format. Prices are from 2022. Consumers can see one hospital at a time by downloading their chargemaster file.  Provided through California OSHPD, the state government Office of Statewide Health Planning and Development.

Colorado Average Cost for Office Visit, ER Visit, Outpatient Tests and Hospital Stay

Find out the average charge and average amounts allowed (cost) for an office visit, ER visit, outpatient tests and hospital stays in Colorado. More than 60 types of hospitalizations and almost 90 outpatient types are listed. Web site shows average price and amount paid in 2020 for each major insurance company. Compare the 9 regions such as Denver, Boulder, Ft. Collins, East CO, etc. Average cost for a 15-minute office visit (code 99213) was $101 in CO in 2020, compared to an average charge of $199. A new patient visit (99203) cost $176 for 30 minutes; the average charge was $288.  The most common type of ER (emergency room department) visit cost $1,293 (allowed) compared to $2,432 in charges. The ER visit code was 99283. The next two most common ER visit types cost $2,202 and $3,586 on average; their charges averaged almost $4,800 and $6,600 respectively. Most likely there were additional tests and imaging charges that were added to the bill.

Almost 13,000 Medicare Advantage cataract and lens procedures were done in 2020 (code 66984). While the average cataract removal charge was over $4,400, the allowed amount was $1,053. The Medicare member was responsible to pay $105 to $227, depending on insurance company. For other insurance, the member might have to pay $943 for a cataract removal. View prices and average costs for colonoscopy and ambulatory knee arthroscopy surgery. Inpatient costs include maternity and newborn charges, C-Section delivery, psychiatric admission, alcohol treatment, rehab, depression, diabetes and many more hospital stays. Consumers may wish to add medical inflation of at least 4.4% for 2022. Provided by the State of Colorado.

Emergency Dept. Report – Florida 2018 prices (pdf)

Find average prices for an Emergency Department visit in Florida in this report. Summary report shows average cost (charges) in 2018 for a hospital ER visit based on acuity. Low acuity Pediatric visit for under age 10 cost about $1,100 in 2018. The more common high acuity pediatric ER visit (through age 17) had an average cost of $3,655, up almost 7% from the prior year. For adults, a high acuity average 2018 charge was $8,164. Common symptoms average cost shown, e.g. $10,506 adults for abdominal pain visit to the ER; $6,215 for back pain; $5,167 for a sprain; $5,450 for a superficial injury/contusion; $2,772 for upper respiratory infection visit; $5,287 for adult pregnancy complication; adult urinary tract infection averaged $7,598. Average pediatric visit for upper respiratory infection cost $2,114. Self-pay uninsured average charge was $1,201 for a low acuity visit, to $6,736 for high acuity. Medical inflation has been more than 13% since 2018, and should be considered in estimating 2023 prices. 26 pages, published by FL Agency for Health Care Admin. This is the latest available report as of July 2023, and it appears Florida has no plans to update the Emergency Department reports.

Florida ER Visit Charges, 2019

Florida ER visit charges for each hospital in 2019. Find the average cost of an emergency room (ER / ED) visit at each Florida hospital in 2019. State average ER visit cost (charge) was $7,321 (about $68 Billion for over 9.2 million ED visits). Average cost was up about 10.8% from 2018. HCA Fawcett Memorial Hospital in Port Charlotte had the highest average charge in FL again in 2019, at a whopping $17,330 per ER visit in 2019. Their average price went up 12.6%. Three additional hospitals had average charges over $16,000: HCA Mercy Hospital a campus of Plantation General Hospital, HCA North Florida Regional Medical Center in Gainesville, and HCA Regional Medical Center Bayonet Point – the same as in 2018. All of the most expensive (average charges) for ED visits are for-profit hospitals. Only 4 hospitals in Florida had an average charge of $1,500 or less. The least cost was Madison County Memorial Hospital in Madison, with an average ER visit cost of just under $1,200.  Number of ER patient visits are shown here. The highest volume Emergency Department was Lakeland Regional Medical Center, with 172,000 visits. Its average price was $7,815.  They are not-for-profit. Complexity and seriousness of the visit vary from hospital to hospital. Easy to use tool, but not severity-adjusted. Average charges for broad diagnostic groups can be found, by using the filters in the search tool. From FloridaHealthFinder.gov.  Check our listing for Hospital Compare to see each hospital’s most recent star ratings and performance on emergency care. The site defaults to 2018 costs, so make sure you check the 2019 box to see the latest. No updates as of March 2023 for 2020, 2021 or 2022 costs of an ER visit. Medical price inflation has gone up about 10.4% since 2019.

Healthcare Expenses for Seniors (MEPS)

Healthcare expenses for seniors are outlined in this MEPS report on Health Care Expenditures for the Elderly Age 65 and over. Median annual expenditures were $4,206 per person (about $5,724 in 2022 dollars). Average annual expenses for those with expense were $9,863 in 2011. Using medical inflation rates, $9,863 is about $13,424 in 2022 dollars. Medicare paid over 62% (up considerably from 10 years earlier); private insurance paid 16%; out-of-pocket amount declined to 12%. 96% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $76 per purchase. For seniors, the inpatient room rate averaged $3,199 per day (sticker shock, and nearly $4,354 in 2022 dollars); ER visit was $884 on average ($1,203 in 2022 dollars); office visit was $228. MEPS Statistical Brief #429 uses 2011 data, published Jan. 2014. Add about 36% to account for medical inflation to 2022.

How Much Does an Office Visit cost compared to an ER visit?

An average physician office visit in 2021 cost $365, compared to $1,164 for an Emergency Room visit. Average expenses went up 9% last year for a physician office visit, and are $100 higher than five years ago. Costs for an ER visit were up 1.2% over last year, and about $160 more than five years ago. Consumers should expect higher costs for 2023 and 2024; $365 in 2021 is about $381 in 2023 using medical inflation factors. With inflation, $1,164 is about $1,215 in 2023 dollars.

MEDIAN expenditure per PERSON with an expense was $513 for office visits and $834 for ER visits. The median expenditures cover the total for the year, including multiple visits. The data from MEPS (Medical Expenditure Panel Survey) informs consumers about the large difference between cost of care in a doctor’s office vs. Emergency Dept, more than 3 times higher. The main link for ER cost and office visit is to the interactive database.

Separately, the most recent MEPS Statistical Brief #517 analyzed Expenses for Office-Based Physician Visits by Specialty and Insurance Type, 2016 . published in October 2018. It is mentioned here only for reference because it shows primary care visit cost $186 in 2016; pediatrics office visit cost $169; ophthalmology visit $307 and OB-GYN visit $280 (all 2016 dollars).

Nevada Hospital Inpatient, ER and Ambulatory Surgery 2022 Average Charges Editor's Pick

Find average hospital, ER, and ambulatory surgery charges in Nevada for 2022. Each hospital is listed by name. Nevada Compare Care shows average hospital charges (prices) for every NV inpatient DRG (Diagnosis Related Group), and overall average ER or ambulatory surgery charge. Overall Nevada 3rd quarter 2022 inpatient charge was a whopping $114,693 per stay, or $20,747 per day. Sample DRGs: Psychoses (average $24,696), Normal Newborn ($6,593), uncomplicated vaginal delivery ($32,945), Septicemia ($175,082 for DRG 871), Major hip or knee replacement ($163,524), Cesarean Section ($53,581 without complications).

The number of ER visits in Nevada during full year 2021 was more than one million. Average 3rd quarter 2022 NV emergency room visit charge was $11,214 statewide. Average ER charges ranged from $2,302 average at Banner Churchill Hospital, to $17,936 average at St. Rose Dominican Siena hospital. Statewide average Ambulatory Surgery Center charge was $8,666. No breakout by procedure type is shown. Endoscopy Center average charges are included. Outpatient surgery at a hospital averaged $55,801 in charges. Standard Reports also show case volume by facility. No information about how much was actually paid. NV reports are a joint effort between Center for Health Information Analysis (CHIA) and the Division of Health Care Financing and Policy (DHCFP).

Vermont – Compare Hospital ER Prices (2022) Editor's Pick

Compare published prices for hospital Emergency Room visits, for all 14 hospitals in VT, according to level of severity and complexity. Statewide average ER price from Oct. 1 2021 to Sept. 30, 2022 is $433 for Level 1 minor problem, before adding tests or procedures. The price has risen an average of 9% per year since 2019. Very few visits are this “simple”. Level 2 low severity ER visit average price was $591 before adding test costs. Level 3 moderate severity and complexity ER visit (the most common in the US) average price is $990 for hospital and physician charges, excluding tests and medications etc. Both Level 2 and Level 3 average prices for an ER visit rose about 6% per year over the past 3 years. Level 4 average price is $1,490.  Top base price for a Level 5 visit was $2,097 per visit ($1,546 hospital, $551 doctor fee). Level 4 and Level 5 Emergency Department visits have risen about 5% per year, over the past 3 years in Vermont.

For consumer planning purposes, billing code Levels 3, 4 and 5 are most likely to occur. A recent study of Medicare patients found that the most common ER visit charge was for a Level 5 visit, right at the top of the complexity scale. Both facility and physician charges are shown – an amazing show of leadership in price transparency. Springfield Hospital’s Level 5 charge is $1,441; the University of Vermont Medical Center’s Level 5 ER charge is over $3,000. Prices do NOT include lab tests, imaging tests or procedures during the ER visit. Prices are good from October 2021 through September 30, 2022. Table 3D published in 2022. Editor’s Pick because VT got this report out while the published prices were still in effect – if even for only a few months.

Virginia Healthcare Prices – ER Visit, Ambulatory Surgery, Test, Hospital Stay Costs

Find Virginia Healthcare Prices for ER visits, ambulatory surgery, tests and hospital stays. This site shows average price ALLOWED (commercial insurance prices) in 2018 for almost 40 common healthcare services in VA. Includes a mix of outpatient, clinic, hospital stays and other services such as an ambulance (median $550) or an emergency helicopter ride ($19,466 which includes average base cost of $14,402 plus mileage). Examples: hospitalizations (maternity), outpatient xray/imaging, CT and MRI tests; colonoscopy, mammogram; inpatient or ambulatory surgery (e.g. hernia, gall bladder, knee replacement, tonsillectomy, kidney stones); and ER or well-child visits (median $126). Shows median and range of costs and provides a breakout by type of cost: facility, surgeon, anesthesiologist, etc. Also shows average price by setting: clinic vs. hospital vs. ambulatory surgical center; and region of Virginia. The median amount allowed for an ER visit (medium, code 99283) was $1,091. The 2020 report shows allowed amounts for each service that you or your insurance plan ACTUALLY PAID in 2018. More relevant than most pricing information, but lags in timeliness. Add at least 12% medical inflation rate to estimate 2022 costs. Virginia Healthcare Pricing Transparency, from Virginia Health Information (VHI), updated June 2020. No new updates as of August, 2022.

Wisconsin ER Hospital Prices (Emergency Department)

Find 2022 ER visit prices to WI hospital emergency departments (ER). Shows median (middle) price for ER (2022) WITHOUT the physician’s fee. It also shows how many cases the hospital treated. Must know how complex the visit is, or use the CPT code. The most common is “high level” of medical decision-making (CPT 99285). Statewide, hospitals charged $2,150 (median charge during 2022) for ER visit 99285. While the tool is slow and cumbersome, Wisconsin Hospital Association’s PricePoint makes comparing hospital prices possible. This site is one of the more up to date sites for healthcare price transparency. Compare hospitals downtown vs. those in the suburbs. Updated 2023. Urgent care prices do not appear to be included any longer, nor are 50 services within Emergency Department visits. Sample median cost for two levels of ER visits:

Nevada Hospital Emergency Room Prices – Compare (free)

Compare Nevada hospital ER visit prices (2021) for common reasons people visit emergency departments. Choose illness and hospital (one hospital at a time). Compare to common charges in the county and NV average. For example, a migraine treated in ER typically cost $7,141 in NV. (Note, the median charge went up 20% per year since 2014, for migraines treated in the ER.) Consumers should also note that physician fees are extra, and NOT shown in the website prices. They may also need to add inflation factors. Prices are disease-specific. Nevada PricePoint through NV Hospital Association.

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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...

average er visit cost in indiana

What common medical visits cost in Indiana - and how they compare to nearby states

In the patchwork of health care providers in the United States, determining what a medical visit might cost can be confusing at best and life-altering at worst. The vast majority of patients who arrive at the hospital for a service recommended by their doctor do so without knowing the cost of that treatment. The price tag on most medical visits is so high for the uninsured, a full one-third of all money raised on GoFundMe is for health care costs.

A raft of legislation in nearly every state is set on tackling some of these endemic issues, with energy aimed squarely at lowering costs and expanding access. Some of this legislation is grand in scope, notably in states like New York where legislators are looking to put a public option on the table for residents there. Other states are taking a narrower approach, requiring providers to release price lists so patients are aware of what their care will cost.

Stacker analyzed cost data released on June 8, 2021, from the Centers for Medicare & Medicaid Services , common provider data from Verywell Health , and state zip codes from Simplemaps to find the average out-of-pocket cost for three typical medical visits in each state .

- Most common family practice visit costs --- Medicare recipients: $98.12 for established patients ($84.54 for new patients) --- Other insurance holders: $24.53 for established patients ($21.14 for new patients) - Most common internal medicine visit costs --- Medicare recipients: $98.12 for established patients ($126.82 for new patients) --- Other insurance holders: $24.53 for established patients ($31.70 for new patients) - Most common pediatric medicine visit costs --- Medicare recipients: $98.12 for established patients ($84.54 for new patients) --- Other insurance holders: $24.53 for established patients ($21.14 for new patients)

In 2020, a major health care transparency bill was signed in Indiana that required providers to publish lists of prices for their services. The purpose of such a requirement is to allow citizens to shop for the best price, thereby lowering their health care costs as much as possible.

Some trends held steady across most states. For family practice and pediatric visits, new patients often pay less than established patients. For internal medicine visits, new patients frequently pay more than established patients. Both of these trends exist regardless of insurance type.

Transparency is increasingly paramount in American health care. Keep reading for a look at what common medical visits cost in neighboring states and the state-level factors that may influence these costs.

- Most common family practice visit costs --- Medicare recipients: $100.66 for established patients ($87.16 for new patients) --- Other insurance holders: $25.16 for established patients ($21.79 for new patients) - Most common internal medicine visit costs --- Medicare recipients: $100.66 for established patients ($130.74 for new patients) --- Other insurance holders: $25.16 for established patients ($32.69 for new patients) - Most common pediatric medicine visit costs --- Medicare recipients: $100.66 for established patients ($87.16 for new patients) --- Other insurance holders: $25.16 for established patients ($21.79 for new patients)

In 2021, Michigan unveiled a bipartisan health care bill intended to lower costs and expand access to care. A significant change proposed in the bill would limit the ability of drug companies to influence doctors through expensive gifts and sponsored trips to prescribe their medications to patients.

- Most common family practice visit costs --- Medicare recipients: $101.20 for established patients ($87.73 for new patients) --- Other insurance holders: $25.30 for established patients ($21.93 for new patients) - Most common internal medicine visit costs --- Medicare recipients: $101.20 for established patients ($131.59 for new patients) --- Other insurance holders: $25.30 for established patients ($32.90 for new patients) - Most common pediatric medicine visit costs --- Medicare recipients: $101.20 for established patients ($87.73 for new patients) --- Other insurance holders: $25.30 for established patients ($21.93 for new patients)

One of the most contentious issues facing Ohioans who are looking to access reliable and affordable health care is the so-called “right to refusal” law. This provision allows providers to opt out of providing care based on ethical or religious objections, which could cause an issue for LGBTQ+ patients looking to access care in the state.

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average er visit cost in indiana

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

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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?

Mother consulting doctor at ER visit

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

How much does an ER visit cost; happy couple drinking coffee

  • 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.

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In this article

  • Introduction

What is the average cost of an emergency room visit?

Will your health insurance cover the emergency room cost, when should you go to the emergency room, determining the average emergency room cost.

Determining the Average Emergency Room Cost

Emergency room (ER) visits are not something anyone plans for, but they are an inevitable fact of life. Whether you're suffering from a serious illness or have been in an accident, there are situations where you need emergency care. While these visits are vital for your health and well-being, they can also come with a hefty price tag if you're uninsured or the reason for your visit isn't covered. That's why it's essential to understand the average price of emergency room visits. You might be surprised how much they can vary depending on your insurance plan and what condition you're there to treat, but there are ways to protect yourself from high medical bills. Check out our guide below to learn what you can expect with regard to the emergency room cost when you are in a life-threatening situation.

According to most sources, the average cost of an emergency room visit in the United States is around $2,200, but  this number can vary depending on a variety of factors, including the severity of the condition, where you live, and what type of insurance plan you have. For example, if you have health insurance through the Affordable Care Act (ACA), your out-of-pocket expenses will be capped. But, even with insurance, you may still end up paying several hundred dollars or more for an ER visit.

The ACA sets a number of limits on the out-of-pocket costs that individuals can be charged for healthcare services, including emergency room visits. However, this does not mean that you will have no cost for these services; it is likely that you may still need to pay copays, coinsurance, or deductibles in addition to what your insurance covers. Additionally, insurers are only required to provide coverage up until a patient's condition becomes stable—any other treatment costs could be on the consumer themselves if they choose an out-of-network provider or hospital.

To reduce the emergency room cost of a visit, you need to understand what kinds of conditions require this level of care. If you can avoid going to the ER for minor issues such as a cold or fever, you may be able to prevent a costly medical bill altogether. Furthermore, if you don’t have health insurance, many hospitals offer payment options like charity care and financial assistance programs to help people manage their medical bills.

It's a common worry for many people—what happens if you suddenly need to go to the emergency room? Will your health insurance cover the cost? Since 2010, the ACA requires insurance companies to cover the care you receive in the ER if you have an emergency medical condition. One of the key provisions of the ACA is that it requires insurance companies to cover emergency medical care for those that have an emergency medical condition regardless. This provision ensures individuals who experience sudden and unexpected medical emergencies will receive the care they need without worrying about the high cost of emergency room visits.

The ACA defines an emergency medical condition as a medical condition that manifests itself in such a way that a reasonable person would believe that the absence or the delay of emergency medical care could result in some type of serious harm or even death. It's crucial to note that the ACA does not require insurance companies to cover non-emergency care in the ER. If you go to the ER for a non-emergency condition such as a headache, flu, or minor injuries, your insurance company may not cover the cost of your visit. Take advantage of resources like our  learning center at HealthInsurance.com to educate yourself on your plan.

EMTs load a patient into the back of an emergency vehicle for transport.

Knowing when to go to the emergency room can be challenging for many individuals, particularly if your goal is to avoid paying a high emergency room cost for a visit that your insurance company deems unnecessary. While some medical emergencies are obvious, others may not be so clear-cut. In general, the emergency room is for medical emergencies that require immediate attention. Conditions that pose an imminent threat to the patient's life or health should be treated as emergencies. Some situations that warrant a visit to the nearest emergency room include:

  • Difficulty Breathing
  • Severe Abdominal Pain
  • Head Injury
  • Loss of Consciousness
  • Allergic Reaction
  • Heart Attack or Stroke Symptoms

Not all conditions require a trip to the ER and you do have some other options to consider when you're experiencing a medical issue. For non-life-threatening conditions, a visit to a primary care physician or urgent care center may be more appropriate. Patients with minor injuries, minor illnesses, or conditions that can wait until the next day or two should consider seeking non-emergency care. As a general rule, if you're in doubt or cannot handle the situation at home, seek emergency care or call 911. It is always better to be safe than sorry when it comes to your health.

The cost of an emergency room visit can vary greatly, depending on the hospital you go to, the level of treatment you require, and your insurance coverage. Knowledge of ER costs can help you make informed decisions when choosing an insurance plan . Some plans may have higher premiums but lower out-of-pocket expenses , while others may have lower premiums and higher costs when you need to use them. By researching the emergency room cost of visits, you'll be able to find a health insurance plan that fits your needs and budget. When you're ready to start learning about your options so you can get the insurance coverage you need, you can visit  HealthInsurance.com to compare plans.

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average er visit cost in indiana

 New Website Compares Indiana Hospital Pricing and Quality

​ easy-to-use resource from indiana hospital association available at mycareinsight.org.

INDIANAPOLIS, Ind .   – Consumers shopping for health care in Indiana can now use a free website to compare hospital charges and quality ratings. Developed by the Indiana Hospital Association, careINsight—or mycareINsight.org —will help Hoosiers better understand what goes into hospital billing and key questions to ask before seeking treatment.

The website, available at mycareINsight.org , displays hospital charge data compiled from the Indiana State Department of Health and based on the 100 most common Indiana inpatient services.

In addition, people who visit the site can compare Indiana hospitals side-by-side based on quality measures data such as patient satisfaction, mortalities, readmissions, early elective deliveries and infections.

“The quality of the care patients receive is just as important as the price. It is important to see other patients’ outcomes when consumers evaluate their treatment options,” said Leonard.

The website includes a video to explain how to navigate the tool to compare hospital charges and quality data, and another that helps consumers understand the high cost of health care .

“It has been very difficult trying to explain to the public the difference between prices and charges in a system where almost no one pays the amount listed on a hospital bill. Everyone pays a different rate,” said Martin Padgett, president and CEO of Clark Memorial Hospital in Jeffersonville and president of the IHA Board of Directors.

Padgett led IHA’s task force of hospital leaders to help guide the development of this new tool. The website will not contain hospital data from private insurance companies, which negotiate payment rates with hospitals and garner discounts for higher volumes.

“Years of government payment shortfalls and commercial insurance negotiations for hospital services have hampered our efforts to tell patients what each procedure cost and why . We want to ensure this tool helps break down the confusion in a way that is easier for everyone to understand,” added Padgett.

The careINsight tool includes a search engine to look up charges by location, hospital and/or procedure. Results will show a hospital-to-hospital comparison by quality and links to hospital websites, as well as provide tips, education and links to financial aid information.

One Procedure. Two Different Hospitals. A Variety of Costs.

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Price Estimates

Learn about your potential billed charges and your expected out-of-pocket costs for iu health services..

As you plan for elective care or the management of a chronic condition, knowing what costs to expect is an important part of being prepared.

Here’s how our price estimate tools and resources work:

  • For insured patients : Your real-time insurance benefits are applied to expected costs to determine the amount you are responsible for paying after insurance.
  • For uninsured patients : Your out-of-pocket costs are based on a discount for the amount generally billed for hospital services. Discounts are also given for IU Health employed physicians’ professional services.

When reviewing the uninsured price estimates, please note that IU Health offers a robust financial counseling program that assists patients and families with the cost of care. IU Health financial counselors are available to assist you with programs such as Medicaid, HIP, CHIP, Marketplace Plans and COBRA. Additionally, we offer a financial assistance policy to all patients, regardless of insurance status, which extends charity to qualifying patients. To learn more please visit our Financial Assistance page.

Self-Service Price Estimate Tool

Use our Self-Service Price Estimate tool to estimate your out-of-pocket cost in real time for more than 700 frequent medical services provided at IU Health hospital locations.

These estimates are based on the typical care experience for patients receiving similar services.

Learn how we can help you with our price estimates for upcoming services so you know what to expect for your care.

Request a Price Estimate

If the service you are planning is not one of the commonly provided services available in our Self-Service Price Estimate tool, the IU Health Price Estimates team is ready to assist you. You can receive an individualized price estimate by completing the online request form below.

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Individualized price estimates are also available by contacting us by phone or email:

Call 317.963.2541 or toll-free at 833.722.6050 Email: [email protected]

Good Faith Estimates

If you don’t have insurance or don’t intend to use insurance to pay for scheduled non-emergency healthcare services, federal law requires that healthcare providers and facilities provide you with an estimate of the expected charges for medical items and services at least 1 business day before the scheduled services are to be performed.

  • If you are uninsured or not using insurance to pay for your healthcare services and receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Any patient may request an estimate of the expected charges for non-emergency healthcare services that have been ordered, scheduled or referred and state law requires that healthcare providers and facilities provide you with an estimate of the expected bill for medical items and services within 5 business days of the request.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • If you request an estimate and the actual charge for the healthcare services exceeds your Good Faith Estimate by the greater of: (i) $100; or (ii) 5%, we will provide a written explanation as to why the charges exceed the estimate.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit cms.gov/nosurprises/consumers or call 800.985.3059 .

Hospital Standard Charge Listings and Urgent Care Average Negotiated Charge Listings

The Centers for Medicare & Medicaid Services (CMS) require hospitals to publish standard charge information and Indiana law requires urgent cares to publish average negotiated charges for common services. This information does not reflect a patient’s financial responsibility or out-of-pocket costs. See IU Health’s charge listings .

Watch CBS News

The most expensive states for ER visits, ranked

By Jessica Learish

December 4, 2020 / 3:56 PM EST / CBS News

Sliding doors of emergency room in hospital

Have you ever been in a hospital emergency room? Maybe you broke your leg or had a burst appendix. When medical emergencies strike, an ER visit could spell the difference between life and death. 

But, like many things in the American  health care system , the cost of this kind of life-saving hospital care varies widely based on where you live or which hospital you visit. 

Hospital Pricing Specialists  collected billing data from nearly 4,500 hospitals across the country to gauge the average price of a moderate-severity  ER visit   — the most common kind of visit — in each state. (Think acute pain of unknown origin, or a fever greater than 100.5 degrees Fahrenheit.)

The overall price tag is made up of emergency room charges, lab and radiology tests, pharmacy and supply costs, and other hospital fees. Each line item also includes charges that go toward paying the health care providers themselves. 

In this gallery, the numbers are presented before any medical insurance is applied. Here are the 50 states (and Washington, D.C.) ranked by the pre-insurance cost of a moderate-severity ER visit.

51. Maryland

Medical Workers Inside Maryland Hospital Work During Coronavirus Pandemic

A moderate-severity ER visit in Maryland costs an average of $623 before insurance.

Nurse caring for patient

Maine hospitals charge an average of $952 for moderate-severity emergency room visits.

49. West Virginia

US-HEALTH-VIRUS-EMERGENCY-MEDIC

A visit to a West Virginia ER will run you $1,127 on average.

48. Montana

Billings County As Covid-19 Cases Surge In Montana

The average price of emergency hospital care in Montana is $1,138.

47. Louisiana

Medical Monitoring Station For Coronavirus Patients Set Up At Morial Convention Center

A visit to a Louisiana ER costs an average of $1,184 before insurance.

To alleviate overcrowding at local hospitals, this New Orleans field hospital was built in 2020 to accommodate up to 1,000 COVID-19 patients.

46. Massachusetts

MGH During Pandemic

Hospitals charge an average of $1,200 for moderate-severity ER visits in Massachusetts.

45. North Dakota

Coney Island Hospital Emergency Room

Have a medical emergency in North Dakota? The average price tag for a moderate-severity visit will be around $1,245.

44. Michican

US-HEALTH-VIRUS-CANADA-DIPLOMACY

Visits to emergency rooms in Michigan cost an average of $1,273.

X-ray image of lung with pneumonia

Kansas hospitals charge around $1,294 per moderate-severity ER visit.

42. Arkansas

United Memorial Medical Center In Houston, Texas Takes On The Coronavirus

It will run you around $1,304 to receive care in an Arkansas ER.

CHRISTMAS LIFESAVERS

Iowa hospitals charge an average of $1,377 per ER visit.

Here, volunteers on the Strawberry Point Ambulance Service pose during a Christmas snowstorm.

40. Vermont

Legs of medic running with gurney along hospital corridor

It costs an average of $1,386 for an ER visit in Vermont.

39. Wyoming

Florida, Miami Beach, broken shoulder, post operative x-ray

Hospitals in Wyoming charge an average of $1,411 per moderate-severity ER visit.

Cleveland As Ohio Covid-19 Cases Surge

Visits to the ER in Ohio cost an average of $1,435 before insurance.

Bay Area Hospital Workers On The Frontlines Of COVID-19 Pandemic

On average, ER visits in Oregon cost $1,437 before insurance.

36. Minnesota

An ambulance on its way to the ER passes the nurses who are protesting the lack of masks and scrubs during the pandemic. They are demanding equipment, training, staffing and transpaency from United hospital and other hospitals.

Minnesota hospitals charge an average of $1,462 per moderate-severity ER visit.

US-HEALTH-BREAST-MILK

In Utah, the average ER visit costs around $1,464.

34. Oklahoma

intubate endotracheal tube

Before insurance, an ER visit in Oklahoma costs around $1,466.

33. Connecticut

US - Ebola - Yale Student tested for Ebola Virus at New Haven Hospital

Connecticut emergency rooms charge an average of $1,493 before insurance.

31 (TIE). Wisconsin

Tensions High In Milwaukee Night After Police Shooting Of Armed Suspect Sparks Violence In City

A moderate-severity ER visit in Wisconsin will cost you around $1,496.

31 (TIE). Alabama

Doctors wrapping African boy's leg in hospital

In Alabama, you'll pay an average of $1,496 for a moderate-severity ER visit.

30. New Mexico

Inside Perry Memorial Hospital As GOP Turns to Modest Obamacare Changes

It costs $1,574 for a moderate-severity ER visit in New Mexico.

29. Mississippi

Busy doctors office

Mississippi hospitals have an average sticker price of $1,583 per ER visit.

28. North Carolina

North Carolina Covid-19 Cases Top 93,000

It costs an average of $1,589 for ER treatment in North Carolina.

26 (TIE). Georgia

Atlanta Emergency Room

Georgia emergency rooms charge an average of $1,596 before insurance.

26 (TIE). Delaware

X–Ray technicians Victor Rios, and Penelope Sanchez, of the St. Francis Hospital Trauma team, prepar

Before insurance, an ER visit in Delaware costs around $1,596.

25. Indiana

Doctor selects information for patient

Hospitals in Indiana charge an average of $1,618 per ER visit.

24. South Dakota

Rural Understaffed Hospitals Get Help From A Virtual ER Staff Via Video

The average sticker price of a South Dakota ER visit is $1,641.

23. Pennsylvania

US-VOTE-BIDEN-POLITICS

A moderate-severity ER visit in Pennsylvania costs $1,645 before insurance.

22. New York

New York City Continues To Idle During Coronavirus Shutdown

The average visit to the ER in New York comes in at $1,668. 

21. Missouri

Medical Debt is a Burden for Both Health Providers and Patients

Missouri hospitals charge $1,717 before insurance.

20. Kentucky

Doctor in hospital taking a swab from patient's mouth

In Kentucky, hospitals bill an average of $1,740 per ER visit.

19. Rhode Island

Coronavirus Pandemic Causes Climate Of Anxiety And Changing Routines In America

Before insurance, the average Rhode Island ER visit costs $1,750.

18. South Carolina

Paramedics taking patient on stretcher from ambulance to hospital

It costs an average of $1,758 for an ER visit in South Carolina.

17. New Hampshire

Bay Area Hospital Workers On The Frontlines Of COVID-19 Pandemic

In New Hampshire, a moderate-severity ER visit costs an average of $1,787.

16. Illinois

What happens to the body during a severe case of coronavirus?

For an ER visit in Illinois, hospitals bill an average of $1,818 before insurance.

15. Washington

Recovered COVID-19 Patients Donate Plasma For Experimental Antibodies Treatment

Washington hospitals charge $1,841, on average, for each ER visit.

Here, a COVID-19 survivor donates convalescent plasma in Seattle.

14. Nebraska

Doctor From Sierra Leone To Be Treated For Ebola At Nebraska Medical Center

Nebraska emergency rooms charge an average of $1,844 before insurance.

13. Washington D.C.

Xinhua Headlines: COVID-19 resurgence puts fragile U.S. economic recovery at risk as states pause reopening

In the nation's capital, hospitals charge $1,879 for the average moderate-severity ER visit.

12. Tennessee

Covid-19 Case Rise In Tennessee As Counties Continue Without Mask Mandate

In this Appalachian state, the average ER visit rings up at $1,883 before insurance.

11. Virginia

US-HEALTH-VIRUS

Hospitals in Virginia charge ER patients an average of $1,941 for moderate-severity cases.

COLORADO COVID-19, AURORA, COLORADO EMERGENCY ROOM

On average, it costs $2,070 to receive ER treatment in Alaska.

Obama Family Friend Taken To Hospital

An ER visit in Hawaii costs an average of $2,076 before insurance.

Hospital emergency room entrance

The average visit to the ER in Idaho comes in at $2,159. 

US-HEALTH-VIRUS-NAVAJO

It costs an average of $2,283 per visit to an Arizona emergency room.

COVID-19 Intensive Care Unit Within A Houston Hospital Cares For Patients As Cases Continue To Rise

Everything is bigger in Texas? The ER bills are certainly quite large. Hospitals charge an average of $2,318 per visit.

Southern Nevada's Healthcare Community Teams Up With Only-In-Las Vegas Pop Up Parades & Performances To Support #MaskUpNV PSA Campaign

Before insurance, the average Nevada emergency room bill rings in at $2,583.

4. Colorado

COLORADO COVID-19, AURORA, COLORADO EMERGENCY ROOM

Hospitals in Colorado charge an average of $2,886 per ER visit.

3. California

First responders in the ER and the ICU at RUHS dealing with COVID-19 victims and trauma victims in Moreno Valley, CA

ER visits in the Golden State cost an average of $2,960 before insurance.

2. New Jersey

First responders in the ER and the ICU at RUHS dealing with COVID-19 victims and trauma victims in Moreno Valley, CA

New Jersey hospitals bill a whopping $3,087 per ER visit before insurance.

COVID-19 Pandemic - Orlando

Florida is the most expensive state for emergency room visits. Moderate-severity ER patients are billed an average of $3,102 before. insurance.

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The most, least expensive states for an ER visit

New Jersey hospitals charge the most for a moderate-severity emergency room visit requiring a single surgery, according to data from Hospital Pricing Specialists provided to Becker's Hospital Review.

For the analysis, Hospital Pricing Specialists collected 12 months of billing data, through June 30, from 4,570 hospitals across the U.S. to determine the average cost of an ER visit for moderate-severity cases that have a single surgery code.

Moderate-severity ER visits are those that fall under the Current Procedural Terminology code 99283. The overall price tag includes charges for ER visits, single surgery codes, lab and radiology tests, pharmacy and supply costs, among other fees.

Below, the 50 states and Washington, D.C., are ranked by the average charge of a moderate-severity ER visit with a single surgery code:

1. New Jersey — $3,750 2. Colorado — $3,377 3. Florida — $3,160 4. California — $2,969 5. Nevada — $2,694 6. Texas — $2,362 7. Arizona — $2,124 8. District of Columbia — $2,100 9. Virginia — $2,013 10. Delaware — $1,983 11. South Carolina — $1,958 12. Kentucky — $1,861 13. Hawaii — $1,846 14. Tennessee — $1,838 15. New Hampshire — $1,811 16. Illinois — $1,804 17. Mississippi — $1,788 18. New York — $1,786 19. Indiana — $1,760 20. New Mexico — $1,748 21. Missouri — $1,733 22. Washington — $1,713 23. Oklahoma — $1,690 24. Rhode Island — $1,639 25. Alabama — $1,628 26. Pennsylvania — $1,628 27. North Carolina — $1,626 28. Georgia — $1,618 29. Idaho — $1,585 30. Oregon — $1,585 31. South Dakota — $1,571 32. Alaska — $1,552 33. Utah — $1,541 34. Ohio — $1,514 35. Connecticut — $1,495 36. Nebraska — $1,445 37. Arkansas — $1,395 38. Wisconsin — $1,369 39. Vermont — $1,283 40. Massachusetts — $1,256 41. Kansas — $1,232 42. Michigan — $1,197 43. Minnesota — $1,191 44. Iowa — $1,173 45. Wyoming — $1,171 46. Louisiana — $1,157 47. West Virginia — $1,087 48. Maine — $965 49. North Dakota — $964 50. Montana — $961 51. Maryland — $710

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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 Twitter , 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:

average er visit cost in indiana

How do health expenditures vary across the population?

average er visit cost in indiana

How does cost affect access to healthcare?

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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Cost of emergency medicine doctor visit in Indiana

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Sidecar Health is modern, common sense insurance that is changing the health industry to give you control over your healthcare costs and choices. Choosing a provider that charges less than the Sidecar Health average cash price for care, results in cash back to our members. As a Sidecar Health member, when you save us money, we think you should pocket the difference, not us.

Pocket the difference

With Sidecar Health insurance, you can choose any of these locations and keep the savings between the Sidecar Health average cash price and what the provider charges. For example, by having your emergency medicine doctor visit performed at one of these locations in Indiana, not only would you have no out-of-pocket costs, you would get to keep up to in savings.*

Pay the difference

As a Sidecar Health member, you can see any provider you want even if they charge more than the Sidecar Health average cash price. You would simply pay the difference between the average cash price and what the location charges. For example, having your emergency medicine doctor visit performed at one of these locations in Indiana would cost you only out-of-pocket.

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* Savings estimate based on a study of more than 1 billion claims comparing self-pay (or cash pay) prices of a frequency-weighted market basket of procedures to insurer-negotiated rates for the same. Claims were collected between July 2017 and July 2019. R.Lawrence Van Horn, Arthur Laffer, Robert L.Metcalf. 2019. The Transformative Potential for Price Transparency in Healthcare: Benefits for Consumers and Providers. Health Management Policy and Innovation, Volume 4, Issue 3.

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Indiana ER Visits Highlight Need for Health Information Access

A study examining patterns in emergency room visits in Indiana finds 40% of patients visit more than one ER, challenging the concept that patients are bound to health systems and repeatedly visit local facilities.

Indiana is the first state to have its emergency care examined for patterns, and the findings could have an impact on health information exchange policy.

Regenstrief

The three-year study by the Regenstrief Institute — a joint enterprise of the Foundation, Inc.; the Indiana University School of Medicine; and the Health and Hospital Corporation of Marion County, Indiana — found that 40% of emergency visits were by patients who visited more than one emergency department (ED).

According to researchers, the discovery challenges the concept that patients are bound to health systems and repeatedly visit local facilities.

The study revealed a wide range of the number of visits per patient to the ED, from one all the way to 385. And nearly all EDs in the state shared patients with almost every other ED.

Shaun Grannis, MD, MS, the senior study author, said the findings are important for strategies and technology being created to link medical information electronically. And the results do challenge “premises upon which health information exchange policy and technology have been based.”

“Since emergency departments can’t predict when patients will appear or know in what other places they have been seen, all EDs need instant access to information from wide swaths of geographic areas and actually the entire nation,” Grannis said.

Better electronic access to a patient’s information is especially important in the ED, where they can be too ill or injured to provide the necessary information — medications, medical history, allergy information, etc.

“What may appear to be a simple problem is no longer simple when someone comes in for a second or third ED visit for the same issue,” said Regenstrief Institute investigator John T. Finnell, MD, MS, an author of the study. “You are no longer thinking ear ache, you are thinking possible bone infection. Knowing that a patient who comes to the ED with chest pain had a recent clear cardiac scan will make a difference in treatment.”

Although specific to Indiana, Finnell said that ED use is likely to be similar in other states.

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Emergency department services

Medicare Part B (Medical Insurance)  usually covers emergency department services when you have an injury, a sudden illness, or an illness that quickly gets much worse.

Your costs in Original Medicare

  • You pay a  copayment for each emergency department visit and a copayment for each hospital service you get.
  • After you meet the Part B deductible , you also pay 20% of the  Medicare-Approved Amount  for your doctor's services.
  • If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment(s) because your visit is considered part of your inpatient stay.   

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
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  • If your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

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

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

Statistical brief #257 costs of emergency department visits for mental and substance use disorders in the united states, 2017.

Zeynal Karaca , Ph.D. and Brian J. Moore , Ph.D.

Published: May 12, 2020 .

  • Introduction

Hospital emergency department (ED) visits have been growing rapidly, with the rate of increase exceeding that for hospital inpatient care. 1 The rate of ED visits for mental health and substance abuse diagnoses increased 44.1 percent from 2006 to 2014, to a rate of 20.3 visits per 1,000 population. 2 According to a 2016 study, ED episodes of care payments represented 12.5 percent of national health expenditures in 2010. 3 Therefore, service delivery costs associated with ED visits are an important health policy concern. Service delivery costs specific to hospital ED use can now be estimated using newly developed Cost-to-Charge Ratios (CCRs) for ED data from the Healthcare Cost and Utilization Project (HCUP).

This HCUP Statistical Brief presents statistics on the costs of ED visits with diagnoses of mental and substance use disorders (MSUDs) in the United States using the 2017 Nationwide Emergency Department Sample (NEDS). ED visits include patients treated and released from the ED as well as those admitted to the same hospital through the ED. Total (aggregate) and average costs for MSUD ED visits are presented by MSUD diagnosis category. Total and average costs for MSUD ED visits are also presented by select patient and hospital characteristics compared with costs for all ED visits. The distribution of total ED visit costs for the five most costly MSUD diagnoses is presented by patient age group and primary expected payer. Because of the large sample size of the NEDS data, small differences can be statistically significant. Thus, only percentage differences in estimates or proportions greater than or equal to 10 percent are discussed in the text.

  • In 2017, mental and substance use disorder (MSUD) emergency department (ED) visits had service delivery costs of more than $5.6 billion, which represented more than 7 percent of the $76.3 billion total ED visit costs.
  • The average cost was $520 per ED visit across the 10.7 million MSUD ED visits, which was similar to the $530 average cost for all 144.8 million ED visits.
  • The five most costly MSUD diagnoses (alcohol-related disorders; anxiety and fear-related disorders; depressive disorders; suicidal ideation/attempt/intentional self-harm; schizophrenia spectrum and other psychotic disorders) accounted for 70 percent of total MSUD ED visit costs.
  • The share of costs for ED visits with routine discharges home was smaller for MSUD ED visits than for all ED visits (70.3 vs. 80.8 percent). In contrast, the share of costs for ED visits resulting in admission to the hospital was larger for MSUD ED visits than for all ED visits (12.5 vs. 9.4 percent).
  • Medicaid had the largest share of ED visit costs for alcohol, suicidal, and schizophrenia disorders; private insurance had the largest cost share for anxiety disorders.

Costs for MSUD ED visits by most costly diagnoses, 2017

Figure 1 presents total and average emergency department (ED) visit costs for the 20 highest cost mental and substance use disorder (MSUD) diagnoses in 2017. Bars in Figure 1 represent the total ED visit cost associated with the diagnosis; the column to the right in the figure provides the average ED visit cost for each diagnosis group. The first- and second-listed diagnoses were used for this analysis; therefore, a single MSUD ED visit can be counted in more than one MSUD diagnosis group (e.g., depressive disorders and alcohol-related disorders) if the ED visit record indicated more than one type of MSUD diagnosis. Thus, the sum of MSUD ED visit costs across diagnoses will not agree with total ED visit costs reported in Tables 1 and 2 because some ED visits are counted in more than one diagnosis category in Figure 1 .

Total and average ED visit costs for the most costly MSUD diagnoses, 2017. Abbreviations: ED, emergency department; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; MSUD, mental and substance use disorder Notes: (more...)

Table 1. Percentage of total costs and average costs for MSUD ED visits by patient characteristics, 2017.

Percentage of total costs and average costs for MSUD ED visits by patient characteristics, 2017.

Table 2. Percentage of total costs and average costs for MSUD ED visits by hospital characteristics, 2017.

Percentage of total costs and average costs for MSUD ED visits by hospital characteristics, 2017.

  • Alcohol-related disorders ($1,220 million, 21.7 percent of the $5,616 million total MSUD ED visit costs)
  • Anxiety and fear-related disorders ($962 million aggregate costs, 17.1 percent)
  • Depressive disorders ($750 million, 13.4 percent)
  • Suicidal ideation/attempt/intentional self-harm ($612 million, 10.9 percent)
  • Schizophrenia spectrum and other psychotic disorders ($364 million, 6.5 percent)

Costs for MSUD ED visits overall and by select patient characteristics, 2017

Table 1 presents the distribution of total costs and the average cost per visit for MSUD ED visits and all ED visits by select patient characteristics in 2017.

  • Young children had a smaller share of MSUD ED costs compared with costs for all ED visits; middle-aged adults had a larger share. Although children aged 0–9 years accounted for 5.6 percent of all ED costs, they represented a smaller proportion of MSUD ED costs (1.1 percent). Adults aged 18–44 years represented a substantial proportion of MSUD ED costs (50.4 percent) but a lower proportion of all ED costs (35.0 percent).
  • The share of costs for routine ED discharges was lower for MSUD ED visits compared with all ED visits; the share of costs for MSUD ED visits admitted to the same hospital was higher. ED visits that ended in a routine discharge (to home) accounted for 80.8 percent of all ED visit costs. In contrast, the percentage of costs for MSUD ED visits with a routine discharge was lower at 70.3 percent. Conversely, MSUD ED visits resulting in inpatient admission to the same hospital represented a larger percentage of MSUD ED visit costs (12.5 percent) compared with all ED visit costs (9.4 percent). Transfers from the ED to other facilities (other than short-term hospitals) represented a larger percentage of MSUD ED visits costs (10.2 percent) compared with all ED visit costs (2.7 percent).
  • Overall, the average cost per ED visit was similar for MSUD ED visits compared with all ED visits. MSUD ED visits overall had an average visit cost of $520 compared with $530 for all ED visits. For most patient characteristics, this relationship held approximately, but there were some exceptions. For patients who were transferred to another short-term hospital or care facility (e.g., skilled nursing or intermediate care facility), average costs for all ED visits were higher than average costs for MSUD ED visits ($1,160 vs. $800 per visit). For children and patients with an expected payer of Medicaid, average costs for MSUD visits were higher than average costs for all ED visits (from 17 to 36 percent higher for children and 19 percent higher for an expected payer of Medicaid).

Distribution of ED visit costs by age group and primary expected payer for the highest cost MSUD diagnoses, 2017

Figure 2 presents the distribution of ED visit costs by age group for the five most costly MSUD diagnoses in 2017.

Distribution of total ED visit costs for the five most costly MSUD diagnoses, by age group, 2017. Abbreviations: ED, emergency department; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; MSUD, mental and substance (more...)

  • The two MSUD diagnoses with the largest percentage of patients aged 65 years and over were anxiety and fear-related disorders and depressive disorders. Among ED visits with at least one of the five most costly MSUD diagnoses, the highest shares of MSUD ED visit costs for patients aged 65 years and older were for anxiety and fear-related disorders (13.9 percent) and depressive disorders (10.2 percent).
  • Approximately one-fifth of ED visit costs for suicidal ideation/attempt/intentional self-harm were for children aged 0–17 years. Although children aged 0–17 years accounted for only 8.1 percent of ED visit costs for the five most costly MSUD diagnoses overall, they accounted for 19.8 percent of ED costs for suicidal ideation/attempt/intentional self-harm and 14.8 percent of ED costs for depressive disorders.

Figure 3 presents the distribution of ED visit costs by primary expected payer for the five most costly MSUD conditions in 2017.

Distribution of total ED visit costs for the five most costly MSUD diagnoses, by primary expected payer, 2017. Abbreviations: ED, emergency department; ICD-10-CM, International Classification of Diseases, Tenth Revision, Clinical Modification; MSUD, mental (more...)

  • Medicaid had the largest share of total costs for ED visits with alcohol-related, suicidal, and schizophrenia diagnoses. Private insurance had the largest share of ED visit costs for anxiety and fear-related disorders. ED visits with a primary expected payer of Medicaid represented the largest share of ED visit costs for alcohol-related disorders (34.7 percent), suicidal ideation/attempt/intentional self-harm (38.0 percent), and schizophrenia spectrum and other psychotic disorders (36.3 percent). ED visits with a primary expected payer of private insurance represented the largest share of ED visit costs for anxiety and fear-related disorders (35.2 percent). The share of ED visit costs for depressive disorders was similar for Medicaid and private insurance (33.4 and 32.1 percent shares, respectively).

Costs for MSUD ED visits overall and by select hospital characteristics, 2017

Table 2 presents the distribution of total costs and the average cost per visit for MSUD ED visits and all ED visits by select hospital characteristics in 2017.

  • The share of MSUD ED costs was higher compared with costs for all ED visits among hospitals located in the Northeast but lower for hospitals in the South. Across regions, the share of MSUD ED costs was higher than the share of costs for all ED visits in the Northeast (23.1 vs. 18.8 percent). The opposite was true in the South where the share of MSUD ED costs was lower than the share of costs for all ED visits (31.0 vs. 36.1 percent).
  • Trauma Level I hospitals had a higher share and nontrauma hospitals had a lower share of MSUD ED costs compared with costs for all ED visits. The share of MSUD ED costs was higher than the share of costs for all ED visits at Trauma Level I hospitals (23.8 vs. 18.3 percent). The share of MSUD ED costs was lower than the share of costs for all ED visits at nontrauma hospitals (46.7 vs. 52.5 percent).
  • About Statistical Briefs

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

  • Data Source

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

  • Definitions

Diagnoses, ICD-10-CM, and Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses

For emergency department (ED) visits that are treated and released, the first-listed diagnosis represents the condition, symptom, or problem identified in the medical record to be chiefly responsible for the ED services provided. In cases where the first-listed diagnosis is a symptom or problem, a diagnosis has not been established (confirmed) by the provider. For ED visits that result in an inpatient admission, the first-listed diagnosis is the principal diagnosis , the condition established after study to be chiefly responsible for the patient’s admission to the hospital. Secondary diagnoses are conditions that coexist at the time of the ED visit or inpatient admission, that require or affect patient care treatment received or management, or that develop during the inpatient stay. All-listed diagnoses include the first-listed (principal) diagnosis plus the secondary conditions.

ICD-10-CM is the International Classification of Diseases, Tenth Revision, Clinical Modification. In October 2015, ICD-10-CM replaced the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis coding system for most inpatient and outpatient medical encounters. There are over 70,000 ICD-10-CM diagnosis codes.

The CCSR aggregates ICD-10-CM diagnosis codes into a manageable number of clinically meaningful categories. 5 The CCSR is intended to be used analytically to examine patterns of healthcare in terms of cost, utilization, and outcomes; rank utilization by diagnoses; and risk-adjust by clinical condition. The CCSR capitalizes on the specificity of the ICD-10-CM coding scheme and allows ICD-10-CM codes to be classified in more than one category. Approximately 10 percent of diagnosis codes are associated with more than one CCSR category because the diagnosis code documents either multiple conditions or a condition along with a common symptom or manifestation. ICD-10-CM coding definitions for each CCSR category presented in this Statistical Brief can be found in the CCSR Reference File , available at www.hcup-us.ahrq.gov/toolssoftware/ccsr/ccs_refined.jsp#download .

For this Statistical Brief, ED visits were categorized using first- and second-listed diagnosis codes. The combination of first- and second-listed diagnosis codes was determined to be a more appropriate method to estimate emergency department (ED) resource use, as ED coding practices may not always use the first-listed diagnosis to capture conditions accountable for the majority of resource use. All-listed diagnoses may be more suitable if the focus of the analysis is ED visit utilization or disease prevalence.

ED visits classified in the same diagnosis category were counted only once, but ED visits that were classified into more than one CCSR diagnosis category were counted separately in each diagnosis category. Therefore, the figures providing costs by diagnosis are not mutually exclusive. Costs for the diagnoses presented in the figures should not be added together.

Case definition

The mental and substance use disorder (MSUD) diagnoses used in this Statistical Brief were defined using diagnosis categories in the CCSR. 6 ED visits for MSUD were identified by scanning the first- and second-listed diagnosis codes on the visit record, assigning CCSR categories to each, and then retaining those codes falling into the mental, behavioral, and neurodevelopmental disorders chapter (i.e., CCSR categories starting with “MBD”). One category in the chapter, MBD024: Tobacco-related disorders, was excluded from consideration.

Types of hospitals included in the HCUP Nationwide Emergency Department Sample

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

Unit of analysis

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

Costs and charges

Total ED charges were converted to costs using HCUP Cost-to-Charge Ratios based on hospital accounting reports from the Centers for Medicare & Medicaid Services (CMS). 7 Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case. For each hospital, a cost-to-charge ratio constructed specifically for the hospital ED is used. Hospital charges reflect the amount the hospital billed for the entire ED visit and do not include professional (physician) fees. Total ED charges were not available on all NEDS records. For this Statistical Brief, aggregate costs were estimated as the product of weighted number of visits and average cost in each reporting category.

How HCUP estimates of costs differ from National Health Expenditure Accounts

There are a number of differences between the costs cited in this Statistical Brief and spending as measured in the National Health Expenditure Accounts (NHEA), which are produced annually by CMS. 8 The largest source of difference comes from the HCUP coverage of ED treatment only in contrast to the NHEA inclusion of inpatient and other outpatient costs associated with other hospital-based outpatient clinics and departments as well. The outpatient portion of hospitals’ activities has been growing steadily and may exceed half of all hospital revenue in recent years. On the basis of the American Hospital Association Annual Survey, 2017 outpatient gross revenues (or charges) were about 49 percent of total hospital gross revenues. 9

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

Expected payer

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

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

For this Statistical Brief, when more than one payer is listed for an ED visit, the first-listed payer is used.

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

Discharge status

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

Hospital characteristics

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

Hospital location is based on a simplified adaptation of the Urban Influence Codes (UIC) developed by the United States Department of Agriculture (USDA) Economic Research Service (ERS). Starting with 2014 data, the categorization is based on the 2013 version of the UIC. Prior to 2014, the categorization was based on the 2003 version of the UIC. The 12 categories of the UIC are combined into four broader categories that differentiate between large metropolitan (1 million residents or more), small metropolitan (fewer than 1 million residents), micropolitan, and non-urban residual (rural).

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

For this Statistical Brief, trauma hospitals were defined as those classified by the ASC/COT as a level I, II, or III trauma center. This is consistent with the classification of trauma centers used in the NEDS. The ACS/COT has a program that verifies hospitals as trauma level I, II, or III. 12 It is important to note that although all level I, II, and III trauma centers offer a high level of trauma care, there may be differences in the specific services and resources offered by hospitals of different levels. Trauma levels IV and V are designated at the State level (and not by ACS/COT) with varying criteria applied across States.

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

  • Alaska Department of Health and Social Services
  • Alaska State Hospital and Nursing Home Association
  • Arizona Department of Health Services
  • Arkansas Department of Health
  • California Office of Statewide Health Planning and Development
  • Colorado Hospital Association
  • Connecticut Hospital Association
  • Delaware Division of Public Health
  • District of Columbia Hospital Association
  • Florida Agency for Health Care Administration
  • Georgia Hospital Association
  • Hawaii Laulima Data Alliance
  • Hawaii University of Hawai’i at Hilo
  • Illinois Department of Public Health
  • Indiana Hospital Association
  • Iowa Hospital Association
  • Kansas Hospital Association
  • Kentucky Cabinet for Health and Family Services
  • Louisiana Department of Health
  • Maine Health Data Organization
  • Maryland Health Services Cost Review Commission
  • Massachusetts Center for Health Information and Analysis
  • Michigan Health & Hospital Association
  • Minnesota Hospital Association
  • Mississippi State Department of Health
  • Missouri Hospital Industry Data Institute
  • Montana Hospital Association
  • Nebraska Hospital Association
  • Nevada Department of Health and Human Services
  • New Hampshire Department of Health & Human Services
  • New Jersey Department of Health
  • New Mexico Department of Health
  • New York State Department of Health
  • North Carolina Department of Health and Human Services
  • North Dakota (data provided by the Minnesota Hospital Association)
  • Ohio Hospital Association
  • Oklahoma State Department of Health
  • Oregon Association of Hospitals and Health Systems
  • Oregon Office of Health Analytics
  • Pennsylvania Health Care Cost Containment Council
  • Rhode Island Department of Health
  • South Carolina Revenue and Fiscal Affairs Office
  • South Dakota Association of Healthcare Organizations
  • Tennessee Hospital Association
  • Texas Department of State Health Services
  • Utah Department of Health
  • Vermont Association of Hospitals and Health Systems
  • Virginia Health Information
  • Washington State Department of Health
  • West Virginia Department of Health and Human Resources, West Virginia Health Care Authority
  • Wisconsin Department of Health Services
  • Wyoming Hospital Association
  • About the NEDS

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

  • For More Information

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

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

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

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

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

  • Acknowledgments

The authors would like to acknowledge the contributions of Gary Pickens and Cory Pack of IBM Watson Health.

The authors have revised this Statistical Brief to use the first- and second-listed diagnosis codes instead of all-listed diagnoses for the purpose of estimating the costs per visit. The combination of first- and second-listed diagnosis codes appears to be plausible for estimating emergency department (ED) resource use, as ED coding practices may not always use the first-listed diagnosis to capture conditions accountable for the majority of resource use. All-listed diagnoses may be more suitable if the focus of the analysis is ED visit utilization or disease prevalence.

Dieleman JL, Squires E, Bui AL, Campbell M, Chapin A, Hamavid H, et al. Factors associated with increases in US health care spending, 1996–2013. JAMA. 2017;318(17):1668–78. [ PMC free article : PMC5818797 ] [ PubMed : 29114831 ]

Moore BJ, Stocks C, Owens PL. Trends in Emergency Department Visits, 2006–2014. HCUP Statistical Brief #227. September 2017. Agency for Healthcare Research and Quality, Rockville, MD. www ​.hcup-us.ahrq.gov ​/reports/statbriefs/sb227-Emergency-Department-Visit-Trends ​.pdf . Accessed March 18, 2020.

Galarraga JE, Pines JM. Costs of ED episodes of care in the United States. The American Journal of Emergency Medicine. 2016;34(3):357–65. [ PubMed : 26763823 ]

The sum of MSUD ED visit costs and percentages of total MSUD ED visit costs across diagnoses will not match costs for ED visits with at least one of the top five MSUD diagnoses because some ED visits are counted in more than one diagnosis category. A separate analysis was run to deduplicate these results when reporting the combined total for the top five most costly MSUD diagnoses in the ED. In addition, total cost for the five most costly MSUD ED visit diagnoses was calculated from values that were not rounded.

Agency for Healthcare Research and Quality. HCUP Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP). Agency for Healthcare Research and Quality. Updated January 2020. www ​.hcup-us.ahrq.gov ​/toolssoftware/ccsr/ccs_refined.jsp . Accessed February 27, 2020.

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

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

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

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

MacKenzie EJ, Hoyt DB, Sacra JC, et al. National inventory of hospital trauma centers. JAMA . 2003;289:1515–1522. [ PubMed : 12672768 ]

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

Karaca Z (AHRQ), Moore BJ (IBM Watson Health). Costs of Emergency Department Visits for Mental and Substance Use Disorders in the United States, 2017. HCUP Statistical Brief #257. May 2020. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/reports/statbriefs/sb257-ED-Costs-Mental-Substance-Use-Disorders-2017.pdf .

(Revised October 2020) *

  • Cite this Page Karaca Z, Moore BJ. Costs of Emergency Department Visits for Mental and Substance Use Disorders in the United States, 2017. 2020 May 12. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb-. Statistical Brief #257.
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In this Page

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

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Your Complete Guide to the 2024 Super Bowl: Teams, Tickets, Taylor Swift, and More

San Francisco 49ers quarterback Brock Purdy (left) celebrates after a touchdown against the Detroit Lions in the NFC championship game in San Francisco on Jan. 28, 2024. Kansas City Chiefs quarterback Patrick Mahomes looks to pass during the AFC Championship against the Baltimore Ravens in Baltimore on Jan. 28, 2024.

A merica is heading for a 2020 rematch in 2024, and no, we’re not talking (just yet) about Joe Biden vs. Donald Trump.

The Kansas City Chiefs and San Francisco 49ers will once again compete in the NFL’s championship match as the two football teams head to Super Bowl LVIII in Las Vegas on Feb. 11, after each winning their respective conference title games on Sunday.

The Chiefs, who are the reigning Super Bowl champions and won the matchup against the 49ers four years ago, are led by generational quarterback Patrick Mahomes and tight end Travis Kelce, who has lit up both the fields and the tabloids this year thanks to his emphatic performances as well as attention-grabbing relationship with singer and TIME Person of the Year Taylor Swift .

APTOPIX Chiefs Ravens Football

The 49ers, meanwhile, are led by polarizing quarterback Brock Purdy, who has responded to wide criticism of alleged mediocrity with consistently impressive stats and clutch comebacks, as well as running back Christian McCaffrey, whose stellar season so far has broken franchise and NFL records .

Both teams and their star players will be looking to make history in football’s final showdown of the 2023-2024 season—and so will the NFL. Last year’s Super Bowl was the most watched U.S. telecast ever . With viewership up this year , this game may just shatter that record, too.

Here’s everything you need to know.

When and where is the 2024 Super Bowl?

Super Bowl LVIII will kick off at 6:30 p.m. ET, Sunday, Feb. 11, at the Allegiant Stadium in Las Vegas. This is the first time either the city, nicknamed the entertainment capital of the world, or the stadium, which opened in 2020 and is normally home to the Las Vegas Raiders, will host the Super Bowl.

How can I watch the 2024 Super Bowl?

The game will be broadcast nationally by CBS, and it can be streamed via Paramount Plus as well as via the NFL Network’s app or website.

Nickelodeon will also be airing an exclusive production tailored for children, with presenters including SpongeBob SquarePants and Dora the Explorer.

More From TIME

Are tickets still available to go to the super bowl.

Official tickets and hospitality packages to watch the match in-person are available via On Location , as well as on resale sites such as TicketMaster , Vivid Seats , Seat Geek , TickPick , and Stubhub —with prices driven by high demand currently ranging from around $7,000 at the lowest end to as much as $90,000.

What Super Bowl ads can we expect?

The Super Bowl is as—if not more— renowned for its commercials as it is for the action between the breaks. This year, AdWeek reports that the program’s pricey spots are “virtually sold out,” and several companies have already begun releasing previews of their celebrity-studded advertisements to come—from mayonnaise maker Hellmann’s teasing an ad featuring comedian and cat lady Kate McKinnon, to beer brand Michelob Ultra putting soccer star and TIME Athlete of the Year Lionel Messi front and center , to gambling facilitator BetMGM sharing its full 60-second plug that pokes fun at seven-time Super Bowl champ Tom Brady as actor Vince Vaughn declares the recently retired quarterback has “won too much” and should “let others have their turn.”

What are the Super Bowl betting odds?

The 49ers are the favorites to win, according to bookmakers, with an opening spread of around 2 points, though that is likely to fluctuate in the run-up to the actual gameday.

Who is performing the 2024 Super Bowl halftime show?

R&B superstar Usher was announced last September as the headline performer of the Super Bowl halftime show, sponsored by Apple Music. 

“It’s an honor of a lifetime to finally check a Super Bowl performance off my bucket list,” the 45-year-old eight-time Grammy winner—who is set to release his ninth album, “Coming Home,” on Feb. 9—said. “I can’t wait to bring the world a show unlike anything else they’ve seen from me before.”

In the past, celebrity guests have sometimes joined the main act, though none have been officially announced yet. A trailer released in January featured appearances by LeBron James, J Balvin, and BTS’ Jung Kook.

There will also be several performances before the game: country musician Reba McEntire is slated to lead national anthem “The Star-Spangled Banner,” while hip-hop artist Post Malone will offer his rendition of “America the Beautiful,” and actress and soul singer Andra Day will perform “Lift Every Voice and Sing”—also known as “ the Black national anthem ” and which has been included in Super Bowl pregame festivities since 2021.

Will Taylor Swift be at the Super Bowl?

Swift, who has become a fixture at her boyfriend Kelce’s games and was there to celebrate the Chiefs victory against the Baltimore Ravens on Sunday to advance to the Super Bowl, has yet to confirm whether or not she’ll be in attendance in Las Vegas on Feb. 11. The global pop star has a scheduled Eras Tour concert in Tokyo on Feb. 10, though social media users have already calculated that she could feasibly still make it back across the world in time.

More Must-Reads From TIME

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  • Issa Rae and Hollywood’s Unkept Promises
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  • The 5 Best New TV Shows of January 2024
  • Taylor Swift Is TIME's 2023 Person of the Year
  • Want Weekly Recs on What to Watch, Read, and More? Sign Up for Worth Your Time

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IMAGES

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  2. Average Cost of an ER Visit

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  3. Costs of Emergency Department Visits By Age

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  4. Cost of Living & Prices in Indiana: 43 cities compared

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  5. Urgent Care vs Emergency Room Costs, Differences and Options

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COMMENTS

  1. Emergency Room

    According to the Medical Expenditure Panel Survey (MEPS), the average cost of an ER visit was $1,150 in 2020, up 6.3% from 2019. (If you add medical inflation to 2022, the ER cost estimate would be about $1,210.) Adults ages 18 to 64 had the highest average visit cost at $1,385. Infants and children under age 18 cost $821 per visit on average.

  2. Cost of an Emergency Room Visit

    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 ...

  3. Emergency Room Visit Cost Without Insurance in 2024

    Alyssa Corso 1 Jan 2024 Average ER Costs Based on The Types of Treatment | Common Reasons For Visiting the ER & Avoidable Visits | Understanding the Emergency Severity Index (ESI) Scale | Insurance Coverage for ER Visits | Factors that Contribute to ER Bills | Alternatives to the Emergency Room | How to Reduce or Dispute an ER Bill | Bottom Line

  4. Standard Charge Listing

    Standard Charge Listing Indiana University Health (IU Health) is committed to helping patients understand their out-of-pocket cost to support patients in making informed decisions about their care.

  5. What common medical visits cost in Indiana

    Stacker analyzed cost data released on June 8, 2021, from the Centers for Medicare & Medicaid Services, common provider data from Verywell Health, and state zip codes from Simplemaps to find the average out-of-pocket cost for three typical medical visits in each state. Indiana - Most common family practice visit costs

  6. Costs of Emergency Department Visits in the United States, 2017

    Average cost per ED visit increased with age, from $290 for patients aged 17 years and younger to $690 for patients aged 65 years and older. As community-level income increased, shares of aggregate ED costs decreased and average cost per visit increased.

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

    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

  8. What is the average cost for an emergency room visit?

    According to most sources, the average cost of an emergency room visit in the United States is around $2,200, but. The ACA sets a number of limits on the out-of-pocket costs that individuals can be charged for healthcare services, including emergency room visits. However, this does not mean that you will have no cost for these services; it is ...

  9. How Much Does an ER Visit Cost in 2022? What to Know

    In 2019, the average cost for an ER visit by an insured patient was $1,082. Those who were uninsured spent an average of $1,220. Average costs can vary by state and illness but range from $623-$3,087. Why an ER visit is so expensive Emergency rooms are very expensive operations to manage for a few reasons.

  10. New Website Compares Indiana Hospital Pricing and Quality

    The website, available at mycareINsight.org, displays hospital charge data compiled from the Indiana State Department of Health and based on the 100 most common Indiana inpatient services.. In addition, people who visit the site can compare Indiana hospitals side-by-side based on quality measures data such as patient satisfaction, mortalities, readmissions, early elective deliveries and ...

  11. Price Estimates

    Contact for Price Estimate. Individualized price estimates are also available by contacting us by phone or email: Call 317.963.2541 or toll-free at 833.722.6050. Email: [email protected]. Request a Price Estimate.

  12. Price Transparency

    The shoppable or all services price list was developed to help you determine the estimated cost for hospital services only. This estimate does NOT include physician costs. Please contact Central Scheduling at 765-983-3358 for more information. Reid Health shall not be liable or responsible for any difference between charges listed in the price ...

  13. The most expensive states for ER visits, ranked

    Here are the 50 states (and Washington, D.C.) ranked by the pre-insurance cost of a moderate-severity ER visit. 51. Maryland. A moderate-severity ER visit in Maryland costs an average of $623 ...

  14. The most, least expensive states for an ER visit

    The overall price tag includes charges for ER visits, single surgery codes, lab and radiology tests, pharmacy and supply costs, among other fees. Below, the 50 states and Washington, D.C., are...

  15. Costs of Emergency Department Visits in the United States, 2017 #268

    All ED visits: $33.7 billion (64.6 million visits) for males; $42.6 billion (80.2 million visits) for females. 0-17 years: $4.0 billion (13.8 million visits) for males; $3.8 billion (13.0 million visits) for females. 18-44 years: $10.7 billion (21.7 million visits) for males; $15.9 billion (32.3 million visits) for females. 45-64 years: $10.4 bi...

  16. Emergency department visits exceed affordability threshold for many

    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 ...

  17. Changes in Emergency Department Visits in the Initial Period of the

    This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on ED visits from 29 States based on the 2019 and 2020 State Emergency Department Databases (SEDD) and a subset of the State Inpatient Databases (SID) that includes information on ED visits that result in an admission to the same hospital. The initial period of the COVID-19 pandemic (April-December 2020) is ...

  18. Cost of emergency medicine doctor visit in Indiana

    $157 Returning patient hospital or surgery center $81 office or urgent care $107 Discover your savings Sidecar Health is modern, common sense insurance that is changing the health industry to give you control over your healthcare costs and choices.

  19. Emergency Visit Claims by Provider and Recipient Age Group

    This dataset provides information related to emergency visit claims. It contains information about the total number of patients, total number of claims, and dollar amount paid, grouped by provider and age group of the recipient. Restricted to claims with service date between 01/2012 to 12/2017. Restricted to top 100 most frequent primary ...

  20. Indiana ER Visits Highlight Need for Health Information Access

    A study examining patterns in emergency room visits in Indiana finds 40% of patients visit more than one ER, challenging the concept that patients are bound to health systems and repeatedly visit local facilities. ... VIDEO: The Costs of EHR. April 15th 2015. Podcast. Youth movement against cholesterol; hospital coffee machines as bacteria ...

  21. Emergency Room Services Coverage

    You pay a copayment for each emergency department visit and a copayment for each hospital service you get.; After you meet the Part B deductible , you also pay 20% of the Medicare-Approved Amount for your doctor's services.; If your doctor admits you to the same hospital for a related condition within 3 days of your emergency department visit, you don't pay the copayment(s) because your visit ...

  22. Costs of Emergency Department Visits for Mental and Substance Use

    Costs for MSUD ED visits by most costly diagnoses, 2017. Figure 1 presents total and average emergency department (ED) visit costs for the 20 highest cost mental and substance use disorder (MSUD) diagnoses in 2017. Bars in Figure 1 represent the total ED visit cost associated with the diagnosis; the column to the right in the figure provides the average ED visit cost for each diagnosis group.

  23. PDF Most Frequent Reasons for Emergency Department Visits, 2018

    Highlights. In 2018, there were 143.5 million emergency department (ED) visits, representing 439 visits per 1,000 population. Fourteen percent of ED visits resulted in hospital admission (61 per 1,000 population). Circulatory and digestive system conditions were the most common reasons for these visits. The majority of ED visits (86 percent ...

  24. Super Bowl 2024: Everything to Know

    Who's playing, how to watch, ticket availability, best ads, betting odds, and, of course, Taylor Swift: All your Super Bowl LVIII questions, answered.