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: Molina Healthcare
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: Molina Healthcare lists clinicians individually: 92% of the 35,904 provider IDs (NPIs) it names are individual doctors, nurse practitioners and therapists; the rest are practices, clinics and hospitals. “Providers” counts those IDs. Molina Healthcare’s files name 33,486 providers for this procedure; 9,045 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: Ohio only for now: Molina sells marketplace plans in 16 states and publishes each state's files separately. Hospital stays: Molina Healthcare's files have no prices for whole hospital stays (the kind billed as one amount per stay), so there are no hospital-stay maps for it. It may pay hospitals by the day or as a share of their charges, which these maps cannot show.
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.