Quick answer
ER bills are high because emergency rooms have to be ready for anything, around the clock, and hospitals charge a separate facility fee on top of the doctor’s fee. Those facility fees have grown fast, and more visits are billed at the highest-complexity levels. For people with large employer coverage, the average ER visit cost $2,453 in 2019, and patients paid $646 of it on average.
Key takeaways
- ER visits come with two main charges: a hospital facility fee and a fee from the doctor who treats you.
- From 2004 to 2021, the average ER facility fee rose from $113 to $713, far faster than doctors’ fees.
- The share of ER visits billed at the highest level (level 5) grew from 5% to 20% of facility claims.
- The No Surprises Act now bans most surprise bills from out-of-network ER doctors and hospitals.
- For minor problems, urgent care or telehealth usually costs much less. See urgent care vs. the ER.
On this page
Why ER bills are so high
- Being ready for anything. ERs are staffed and equipped 24 hours a day for everything from a sprain to a heart attack, and that readiness is built into the prices.
- Care for everyone. Under a federal law called EMTALA, hospitals with emergency departments must screen and stabilize anyone who comes in, whether or not they can pay. Hospitals make up for unpaid care in part through higher prices.
- Facility fees. On top of the doctor’s bill, hospitals charge a facility fee for the ER itself. Facility fees have grown much faster than doctors’ fees.
- Higher billing levels. ER visits are billed at levels 1 to 5 based on complexity, and more visits are now billed at the top levels.
- Tests and imaging. Lab work, X-rays and CT scans are billed separately and add up quickly.
| ER charges for people with large employer coverage | Then | Later |
|---|---|---|
| Average facility fee | $113 (2004) | $713 (2021) |
| Average doctor’s fee | $138 (2004) | $321 (2021) |
| Level 5 share of facility claims | 5% | 20% |
Surprise bills are mostly banned now
Before 2022, many ER patients got surprise bills from out-of-network doctors. The No Surprises Act changed that: for emergency care, your plan must charge in-network cost-sharing even at an out-of-network ER, and out-of-network doctors can’t bill you for the difference. Ground ambulances aren’t covered by the law; see does health insurance pay for ambulance rides. For your coverage rights in the ER, see will health insurance cover emergency room visits.
How to lower an ER bill
- Wait for your explanation of benefits. Compare it with the bill and pay only what you owe; see what is an explanation of benefits.
- Ask for an itemized bill. Look for duplicate charges, services you didn’t get, and a billing level that doesn’t match your visit.
- Call about a surprise bill. If you’re billed more than in-network cost-sharing for emergency care, call the No Surprises Help Desk at 1-800-985-3059.
- Appeal a denial. If your insurer says it wasn’t an emergency, send records of your symptoms; see how to appeal a claim denial.
- Ask about financial assistance. Nonprofit hospitals must have financial assistance policies, and many hospitals offer payment plans or discounts for paying promptly.
If you can’t pay right away, see what’s the worst that can happen if I don’t pay my medical bill and do unpaid medical bills hurt your credit.
When to use urgent care instead
For a sprain, a minor cut, a fever or a sore throat, urgent care or a telehealth visit is usually faster and much cheaper. Call 911 or go to the ER for chest pain, trouble breathing, signs of a stroke, severe bleeding or a serious injury. Don’t let cost stop you in a real emergency.
Protecting yourself
Your plan’s out-of-pocket maximum caps what you pay for covered in-network care in a year; see what is an out-of-pocket maximum. High ER prices are also part of why health insurance is so expensive.
Related guides: what an ER visit costs without insurance and what urgent care costs without insurance.
Compare plans in your area: see quotes by ZIP code.
Frequently asked questions
How much does an ER visit cost?
For people with large employer coverage in 2019, the average visit cost $2,453, and patients paid $646 of it on average. Costs vary widely by what you need.
Why did I get two bills for one ER visit?
Hospitals bill a facility fee, and the doctors who treat you bill separately. You may also get bills for imaging or lab work.
Can I negotiate an ER bill?
Yes. Ask for an itemized bill, point out errors, and ask about financial assistance, payment plans or a prompt-pay discount.
Does insurance cover an out-of-network ER?
Yes. For emergency care, you pay in-network cost-sharing, and most surprise bills are banned.
Sources
This article is general information, not medical or financial advice. In an emergency, call 911. Last reviewed September 2026.