Price Checker / CPT 99285
How much does ER visit — severe/critical (level 5) cost?
CPT 99285 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is roughly 9.8x the fair price. This is well above fair — push back or dispute it.
Fair price
$260–$510
What this should cost
With insurance
~$75,600
Typical out-of-pocket
Overcharged if over
$640
Push back above this
The average hospital charge of $3,827 is $3,437 over the fair price (about 9.8x the fair rate).
What hospitals charge for ER visit — severe/critical (level 5)
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Gateway Regional Medical Center Granite City, IL | $8,593 | — | 14844% |
| PRISCILLA CHAN & MARK ZUCKERBERG SAN FRANCISCO GENERAL HOSPITAL & TRAUMA CENTER , CA | $17,602 | $17,602 | 10173% |
| Sharp Memorial Hospital SAN DIEGO, CA | $15,200 | $11,400 | 8771% |
| "UH Rainbow Babies & Children's Hospital" , OH | $10,275 | $7,706 | 5896% |
| University Hospitals Cleveland Medical Center , OH | $10,275 | $7,706 | 5896% |
| Driscoll Children's Hospital - Rio Grande Valley Edinburg, TX | $3,371 | — | 4452% |
| Southern Humboldt Community Hospital GARBERVILLE, CA | $7,253 | — | 4133% |
| Palomar Health Medical Center Escondido Escondido, CA | $7,157 | — | 4077% |
| Palomar Medical Center Poway Poway, CA | $7,157 | — | 4077% |
| Wilson Medical Center WILSON, NC | $5,228 | — | 2951% |
| 62-1113167 BMH Tipton , TN | $4,703 | $1,129 | 2645% |
| UM R Adams Cowley Shock Trauma Center Baltimore, MD | $4,211 | — | 2357% |
| 23330 Emergency Center, LLC d/b/a/ Elite Hospital Kingwood Kingwood, TX | $4,080 | — | 2281% |
| Ascension Saint Thomas Hickman , TN | — | — | 2249% |
| Grundy County Memorial Hospital GRUNDY CENTER, IA | $3,721 | — | 2072% |
Were you billed for this procedure?
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About ER visit — severe/critical (level 5)
CPT code 99285 refers to er visit — severe/critical (level 5) (billing description: "Emergency dept visit hi mdm"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $171 in a facility (hospital or surgery center) and $171 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.