In an emergency, call 911 or go to the nearest ER. Hospitals with emergency departments must screen and stabilize you regardless of ability to pay (EMTALA). The bill comes later, and there are ways to lower it.[1]
ER visit cost without insurance, by visit level
A level 3 ER visit costs $370–$1,150 without insurance, a level 4 visit $580–$1,800 and a level 5 visit $830–$2,600, counting both the hospital and the doctor. Hospitals assign each emergency visit one of five levels after the fact, based on how much care and how many resources it took; levels 1 and 2 cover minor problems. Medicare pays the hospital a set amount for each level and pays the emergency physician separately.[2][3]
| Level | Hospital code | Doctor code | Medicare: hospital | Medicare: doctor | Low | Typical | High |
|---|---|---|---|---|---|---|---|
| Level 3 (moderate) | APC 5023 | 99283 | $306 | $68 | $370 | $650 | $1,150 |
| Level 4 (high urgency) | APC 5024 | 99284 | $467 | $116 | $580 | $1,000 | $1,800 |
| Level 5 (most severe) | APC 5025 | 99285 | $663 | $169 | $830 | $1,450 | $2,600 |
The low end is what Medicare pays; the typical and high figures come from the cash prices hospitals post. In late 2022, the median posted cash price for the facility fee alone was $420 at level 3, $699 at level 4 and $1,059 at level 5, about 1.8 to 2.0 times Medicare Advantage rates, with half of hospitals listing even higher prices.[4]
Two bills: the hospital and the emergency doctor
An ER visit produces at least two bills: one from the hospital for the facility (staff, room, equipment) and one from the emergency physician or the physician group the hospital contracts with. The facility fee is the larger part. In Medicare's rates it is about 80% of a level 4 visit, and in large employer plans facility fees made up 80% of the total cost of an ER visit in 2019.[5] The doctor's bill may arrive separately, from a physician group whose name you may not recognize.
What else ends up on an emergency room bill
The emergency room cost without insurance grows quickly once tests are added, because every scan, lab test, medicine and procedure is billed as its own line at hospital prices. Here is a worked example of a level 4 visit with common tests:
| Line on the bill | Low | Typical | High |
|---|---|---|---|
| ER visit, level 4 (facility + doctor) | $580 | $1,000 | $1,800 |
| CT head without contrast | $430 | $730 | $1,100 |
| Chest X-ray, 2 views | $200 | $330 | $500 |
| Metabolic panel + blood count (one blood draw) | $40 | $110 | $280 |
| Total | $1,250 | $2,170 | $3,680 |
For comparison, the average ER visit cost $2,453 in large employer plans in 2019 (insurer and patient payments combined), of which patients paid $646 out of pocket on average.[5] Scan prices are covered in more detail on our CT scan cost and X-ray cost pages, and lab tests on blood work cost. If you are admitted to the hospital or kept for observation, the bill becomes an inpatient or observation bill, which these estimates do not cover.
Ambulance cost without insurance
An ambulance ride is billed separately by the ambulance service, not by the hospital, and it is not included in the estimates on this page. Local fire departments and other government agencies provided 62% of emergency ground ambulance rides in a 2020 national dataset, private companies 30% and hospital-owned ambulances 8%; some publicly run services do not bill patients at all.[11] Prices vary by service and area, so ask the service directly.
- Ask the service for an itemized bill (for example, the base rate and the mileage) and for its self-pay or hardship policy.
- If the service is run by your city or county, ask whether residents are billed differently.
- Ground ambulances are not covered by the No Surprises Act's billing protections, which apply to insured patients.[12]
- Ambulance costs count as medical expenses for HSA, FSA and tax-deduction purposes.[13]
What affects the price of an ER visit
| Factor | Effect on price | Why |
|---|---|---|
| Visit level | $650 at level 3 to $1,450 at level 5, typical | Assigned by the resources your visit used |
| Tests and treatment | Often more than the visit itself | Each scan, lab test and medicine is billed at hospital prices |
| The hospital's list prices | Can be several times its costs | In 2012 hospitals charged 3.4 times their costs on average, and the uninsured were commonly asked to pay full charges[6] |
| Nonprofit or for-profit hospital | Nonprofits must cap charges for eligible patients | Federal tax rules require financial assistance policies |
| Your area | Follows local wages and costs | Medicare adjusts the hospital and doctor rates by area |
How to lower an ER bill without insurance
You cannot shop for emergency care in advance, and the good faith estimate rules apply to scheduled care, not emergencies,[10] so the savings come after the visit:
- Ask for an itemized bill from both the hospital and the physician group, with the visit level and each code. Check for duplicates and services you did not receive.
- Ask for the hospital's self-pay price. Hospitals must publish the discounted cash prices they offer[7]; if your bill is above the posted price, ask for it.
- Apply for financial assistance. At a nonprofit hospital, patients who qualify under its financial assistance policy cannot be charged more for emergency care than the amounts it generally bills insured patients.[8] You can apply for at least 240 days after the first bill.[9]
- Make a counteroffer based on the Medicare amount the estimator shows; our guide to negotiating medical bills walks through it.
- For non-emergencies next time, compare urgent care prices, which are a fraction of an ER visit for minor problems.
Frequently asked questions
What is the ER visit cost without insurance if I am just checked and sent home?
If you only need an exam and simple care, expect a level 3 or 4 visit: about $370–$1,150 or $580–$1,800 at national self-pay prices, including the doctor. Any test or medicine adds to that.
Can the ER refuse to treat me without insurance?
No. Medicare-participating hospitals that offer emergency services must provide a medical screening exam to anyone who asks and stabilizing treatment for an emergency condition, regardless of ability to pay.[1] They can bill you afterward.
How much does an ambulance cost without insurance?
It depends entirely on the service that sends it: most emergency rides are run by fire departments or other government agencies, and some of those do not bill patients at all.[11] Ask the service for an itemized bill and its hardship policy.
Is urgent care cheaper than the emergency room without insurance?
Yes, for problems urgent care can handle. A simple urgent care visit typically costs $170, against $650 for a level 3 ER visit. See going to urgent care without insurance.
Sources
- Emergency Medical Treatment & Labor Act (EMTALA)
- CY 2027 OPPS/ASC final rule with comment period (CMS-1850-FC) and Addenda A and B
- Medicare Program; CY 2027 Payment Policies Under the Physician Fee Schedule (CMS-1848-F)
- Payer Type and Emergency Department Visit Prices (Morey et al.)
- Emergency department visits exceed affordability thresholds for many consumers with private insurance
- Extreme Markup: The Fifty US Hospitals With The Highest Charge-To-Cost Ratios (Bai, Anderson)
- 45 CFR Part 180: Hospital price transparency (standard charges, discounted cash price, shoppable services)
- 26 CFR 1.501(r)-5: Limitation on charges (amounts generally billed)
- 26 CFR 1.501(r)-1: Definitions (240-day financial assistance application period)
- Good faith estimate guide (No Surprises Act, uninsured and self-pay patients)
- Ground ambulance rides and potential for surprise billing (Amin, Pollitz, Claxton, Rae, Cox)
- Know your rights when using health insurance
- Publication 502: Medical and Dental Expenses