What Insurers Pay for ER Visit, Level 4 (CPT 99284): 2026 Benchmarks
Part of our payer reimbursement benchmarks series — 16 payers cover 99284, with a national median of $670 and a 13.5× spread between the highest- and lowest-paying payers.
Official CMS descriptor: Emergency dept visit mod mdm
National benchmarks
What this number is — and isn’t
This is the facility fee— what the insurer has contracted to pay the hospital or surgery center for this specific billing code, as published in the insurer’s Transparency in Coverage filing. It covers the technical or facility component of the procedure only. Most care episodes generate additional bills: a separate physician fee (billed under the same CPT as a professional claim), anesthesia, and follow-up care — so an all-in episode total is typically several times this line item. This number is not a patient cost estimate; what you owe depends on your deductible, coinsurance, and the other codes billed.
By payer
Negotiated medians by payer
| Payer | Median rate | States covered |
|---|---|---|
| Cigna | $1,759 | 56 |
| Blue Cross Blue Shield of Nebraska | $1,743 | 54 |
| Blue Cross Blue Shield of Florida | $1,253 | 55 |
| 10 more payers between these — medians by payer and state Unlock with Pro → | ||
| Blue Cross Blue Shield of Kansas† | $164 | 45 |
| Blue Cross Blue Shield of Wyoming† | $151 | 48 |
| Blue Cross Blue Shield of North Dakota† | $131 | 52 |
† Likely reflects a percent-of-billed-charge, case-rate, or per-diem contract structure rather than a comparable fee-schedule rate. See methodology.
Payer-level medians are aggregated across all states each payer covers. Filter to your payer and state →
Rates by state
| State | Median | Coverage |
|---|---|---|
| SC | $1,097 | Full |
| MP | $1,068 | Partial |
| WV | $1,052 | Partial |
| NC | $1,028 | Full |
| OH | $1,021 | Partial |
| All 56 states and territories, including yours Unlock with Pro → | ||
Showing the 5 highest-median states. State medians are computed from payer-level medians; cells with fewer than 5 underlying rates are suppressed.
Methodology
The national median for 99284 is computed using a median-of-state-medians method: within each state we compute the median of all payer-reported in-network rates, then take the median of those state medians. This prevents high-volume states from dominating the national figure.
Cells with fewer than 5 underlying rates are suppressed before aggregation to prevent thin markets from distorting state or national summaries. An institutional billing class means rates reflect the facility fee schedule — what a hospital or ambulatory surgery center bills. The two billing classes are not directly comparable for the same procedure code.
All rates are derived from federally-mandated Transparency in Coverage Machine-Readable Files (45 CFR Part 147). We do not model, estimate, or invent prices — every figure traces back to a payer-published filing. A median is a summary, not a quote. No individual provider necessarily charges the median; percentile ranges exist precisely because prices vary. Verify specifics with your payer or provider. See our full methodology.
Payers contract under different structures (fee schedule, percent of billed charges, case rates); medians that diverge sharply from the national range usually reflect a different payment methodology rather than a genuinely different price.
CareCost Explorer, “Negotiated rate benchmarks for CPT 99284,” 2026-Q2 Transparency in Coverage data, carecostexplorer.com/benchmarks/procedure/99284. Generated 2026-06-12.
Journalists and researchers: this data is free to cite with attribution.
Frequently Asked Questions
What is the average negotiated rate for CPT 99284?
Why do rates for CPT 99284 vary 13.5× between payers?
What does the institutional rate for CPT 99284 cover?
How do I find my payer's rate for CPT 99284 in my state?
See the rate for your payer, in your market.
Cigna's median for 99284 is $1,759 — but your state and plan tell a different story. 36M+ rates, queryable.