Heads up: Level 4 (99284) is the most common ER billing level for urgent visits. Level 5 (99285) applies to critical or highly complex cases and runs 20–40% higher.
ER visit codes reflect the complexity of the evaluation — not the severity of your condition as you experience it. The level is determined by the physician after the visit based on how many problems were addressed and how much decision-making was involved. You can't predict which level you'll be billed for in advance.
Tip: ER visits for urgent but not critical conditions (kidney stones, fractures, chest pain workup) typically bill as 99284 or 99285. The facility fee is separate from the physician fee.
| Code | Variant | When it applies | |
|---|---|---|---|
| CPT 99281 | Level 1 — Minimal | Simple problem, limited evaluation | See exact rates → |
| CPT 99282 | Level 2 — Low | Low complexity | See exact rates → |
| CPT 99283 | Level 3 — Moderate | Moderate complexity — most common for urgent but not critical visits | See exact rates → |
| CPT 99284 | Level 4 — High | High complexity — significant workup | See exact rates → |
| CPT 99285 | Level 5 — Highest | Highest complexity — critical or life-threatening | See exact rates → |
Ranges span all billing codes for this procedure. Actual rate depends on which variant is performed.
| Insurance | AdventHealth Tampa | AdventHealth Wesley Chapel | AdventHealth Zephyrhills | HCA Florida Brandon Hospital | HCA Florida Largo Hospital | HCA Florida South Tampa Hospital | HCA Florida Trinity Hospital | HCA Florida West Tampa Hospital |
|---|---|---|---|---|---|---|---|---|
| Medicare | $11–$174Best | $11–$174Best | $11–$174Best | $11–$174Best | $11–$174Best | $11–$174Best | $11–$174Best | $11–$174Best |
| Workers Comp | — | — | — | $124–$746Best | $124–$746Best | $124–$746Best | $124–$746Best | $124–$746Best |
| Aetna | $197–$2,929Best | $197–$2,829Best | $197–$2,892Best | $0 covered | $0 covered | $0 covered | $0 covered | $0 covered |
| Multiplan | $231–$3,639Best | $268–$4,221 | $268–$4,221 | $0 covered | $0 covered | $0 covered | $0 covered | $0 covered |
| Humana | $1,387–$1,594 | $171–$1,494Best | $308–$1,337 | — | — | — | — | — |
| Oscar Health | $860–$1,807 | $892–$1,874 | $979–$2,056 | $599–$3,602Best | $599–$3,602Best | $599–$3,602Best | $599–$3,602Best | $599–$3,602Best |
| Blue Cross Blue Shield | — | — | — | $574–$2,490Best | $574–$2,490Best | $732–$3,276 | $967–$5,072 | $732–$3,276 |
| Self-pay (uninsured) | $123–$1,941Best | $123–$1,941Best | $123–$1,941Best | $2,606–$7,106 | $2,198–$7,655 | $2,200–$6,602 | $2,565–$6,595 | $2,200–$6,602 |
| Cigna | $277–$1,167Best | $293–$1,414 | $298–$1,504 | $4,670 | $4,670 | $4,670 | $4,670 | $4,670 |
Source: Hospital price transparency files (federally required). Facility fees only.
Each hospital negotiates separate contracts with every insurer. For the same procedure, the rate can differ by 3–5x between hospital systems — larger systems have more leverage and command higher rates.
Facility fee only. The physician performing this procedure bills separately. Your out-of-pocket depends on your deductible and coinsurance. Federal law requires hospitals to provide a Good Faith Estimate before any non-emergency procedure.