How Much Does Emergency Room Visit - High Complexity Cost?
Also known as: Emergency dept visit mod mdm (CPT 99284)
A serious emergency room visit for conditions that need urgent and detailed evaluation, often involving multiple tests.
Emergency Room Visit - High Complexity (CPT 99284) costs $118 at Medicare rates.
The rates shown below represent the complete Medicare reimbursement for this service. No separate facility fee applies for this type of procedure.
Patient Guide: Emergency Room Visit - High Complexity
What you need to know before your appointment
What to Expect
Expect extensive testing including blood work, imaging, and possibly specialist consultations. You may receive IV medications and be closely monitored.
How Long Does It Take?
4-8 hours
Common Reasons Doctors Order This
Serious injuries, significant chest pain, stroke symptoms, severe allergic reactions, broken bones
How to Prepare
Call 911 for life-threatening emergencies. Bring all medications, insurance info, and emergency contacts.
Procedures Commonly Done Together
These procedures are frequently performed alongside Emergency dept visit mod mdm
What Insurance Companies Actually Pay
Real negotiated rates from 16 hospitals across 6 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $2,781 | $221 - $6,613 | 9 |
| Cigna | $3,189 | $400 - $8,729 | 10 |
| United | $2,271 | $226 - $6,138 | 10 |
| Humana | $1,340 | $224 - $2,548 | 8 |
| BCBS | $2,087 | $229 - $3,360 | 5 |
| Molina Healthcare | $320 | $320 | 3 |
| BCBS-TX | $834 | $514 - $1,119 | 3 |
| Multiplan | $3,576 | $692 - $12,275 | 6 |
| Kaiser | $1,772 | $1,007 - $3,723 | 2 |
| Wellpoint | $388 | $175 - $640 | 2 |
| CHC | $1,578 | $314 - $2,156 | 2 |
| Anthem | $5,300 | $2,740 - $10,093 | 2 |
How to Reduce Your Cost for Emergency dept visit mod mdm
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
Some procedures cost significantly less in an office setting than a hospital. Ask your provider about options.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (3.54) x CF ($33.40) = $118
Related Procedures
Similar procedures in the same category or body system
Consider These Alternatives
Depending on your clinical situation, these alternatives may be appropriate and could save you money.
Note: Alternative procedures may not be clinically appropriate for all patients. Always consult your physician to determine the best option for your specific situation.
People Also Ask
Common questions people search for about this procedure
Will insurance cover ER visits?
Insurance will have a major impact on what you'll pay for your ER visit. If you have health insurance, your emergency care should be covered, no matter where you are, at your plan's in-network levels (although there are exceptions).
Will urgent care prescribe Zofran?
What happens if I go to the ER and can't pay?
You simply have to ask. Inquire about financial assistance. Nonprofit hospitals are required to offer charity care or discounted care based on income. You may qualify for aid retroactively, even if your bill is already in collections.
Frequently Asked Questions
How much does Emergency dept visit mod mdm cost?
The Medicare facility rate for Emergency dept visit mod mdm is $118. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Emergency dept visit mod mdm cost without insurance?
Without insurance, the cost of Emergency dept visit mod mdm can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Emergency dept visit mod mdm?
Most commercial health insurance plans and Medicare cover Emergency dept visit mod mdm when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.