Emergency room visit (most complex)

An ER visit for a severe or life-threatening problem needing the highest level of care.
Code 99285 · Emergency & hospital · statewide summary · negotiated in-network prices
Payers shown: Moda Health
Prices shown: emergency department visits
Doctor’s fee or facility fee? These are the emergency doctor's fees only. The hospital bills its own emergency-room facility fee on top, usually several times larger, and it is not included here.
Who is counted: Moda Health lists clinicians individually: 92% of the 96,844 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs. Moda Health’s files name 66,937 providers for this procedure; 15,048 are counted here: the clinicians whose specialty performs it — mostly Nurse Practitioner, Physician Assistant and Emergency Medicine — and the practices, clinics and hospitals. Insurers attach their whole fee schedule to every contracted provider, so the rest are clinicians listed at a price for something they never do; counting them would inflate the provider count and pull the typical price towards the fee schedule’s floor.
Not on this map: These are Moda's September 2026 files: half of its October files were not yet posted when this was built. Care outside Moda's area: for some plans, Moda rents Aetna's national network. Those prices are Aetna's, so they are not included here.
StateProvidersNamed in filesOrganisationsZip codes Lowest25th pctMedian75th pctHighestvs Medicare
“x Medicare” compares each price with what original Medicare pays a doctor for the same service in the same state under its physician fee schedule (RVU26D, in force from 2026-10-01) — the lower price a doctor is paid when a hospital or surgery center provides the room and equipment. Insurers write their contracts as a share of Medicare, so 1.3x means the insurer pays 30% more than Medicare would; Medicare Advantage plans generally pay close to 1.0x.
This is a statewide summary. Prices vary far more between towns and between practices than these medians suggest; zip-code and provider-level detail is not published here; this specific data can be requested here.