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Kentucky

Cost of a ER Visit (Moderate) Visit
in Kentucky

Reviewed by Momentary Medical Group West PC

Kentucky's expanded Medicaid program covers over 600,000 residents, yet emergency department utilization remains higher than national averages across the Commonwealth. For a ER Visit (Moderate) visit, patients typically pay between $70 and $246, with a median out-of-pocket cost of $103, based on negotiated rates from 405 active providers statewide. Kentucky maintains a robust network of emergency medicine specialists across both urban medical centers in Louisville and Lexington and rural critical access hospitals, allowing patients to browse providers throughout the state.

Average

$140

Median

$103

Lowest

$70

Highest

$246

Providers

405

National avg: $142Kentucky: $140

2% below national average

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Compare Similar Procedures

How does er visit (moderate severity) compare to related procedures in Kentucky?

ProcedureCPTLowMedianHighProviders
ER Visit (Low Severity)

Emergency department visit, low severity

99283$40$85$139378
ER Visit (High Severity)

Emergency department visit, high severity

99285$80$88$2961,050

Important: These are cost estimates only — not a quote and not medical advice.

The prices on this page are self-pay rates, drawn from federal Transparency in Coverage machine-readable files (CPT 99284 — Emergency department visit, moderate severity). They represent what a patient might pay without insurance.

Your actual cost depends on: your specific insurance plan, your remaining deductible, your coinsurance percentage, whether you have met your out-of-pocket maximum, whether the facility and provider are both in-network, and any separate anesthesia or implant fees billed independently.

This page does not constitute medical advice. Whether you need this procedure, and which approach is right for you, is a decision to make with a licensed healthcare provider.

Where this data comes from & what CPT 99284 covers

Data source: Cost figures are derived from UnitedHealthcare Transparency in Coverage machine-readable files for CPT code 99284 (Emergency department visit, moderate severity), as mandated by the CMS Price Transparency Rule.

What CPT 99284 covers: the provider's professional fee for er visit (moderate severity). It does not include facility/hospital fees, anesthesia, pre-operative imaging, post-operative care, or any add-on codes billed separately.

How to read this data

Negotiated Rate

The discounted price an insurer has agreed to pay a specific provider. Most insured patients' bills are calculated from this number, not the higher list price hospitals publish separately.

P5, Median, P95

P5 is the rate at the 5th percentile (low end), Median is the middle value, and P95 is the 95th percentile (high end). This range shows how much the same visit can vary between providers.

What this does not tell you

These rates do not tell you what you personally will pay out of pocket. That depends on your specific plan, how much of your deductible you have already met, your coinsurance rate, and whether the provider is in your network. Call your insurer's member line to get your exact estimate.

Top-Rated Hospitals in Kentucky

These hospitals in Kentucky are top-rated for patient satisfaction. Review data sourced from HCAHPS Patient Survey.

CHI SAINT JOSEPH BEREA NF

BEREA, KY

5/5
88% would recommend102 patient surveys
FLEMING COUNTY HOSPITAL

FLEMINGSBURG, KY

5/5
85% would recommend117 patient surveys
THREE RIVERS MEDICAL CENTER

LOUISA, KY

5/5
84% would recommend134 patient surveys
BAPTIST HEALTH LEXINGTON

LEXINGTON, KY

4/5
84% would recommend1,537 patient surveys
HARRISON MEMORIAL HOSPITAL

CYNTHIANA, KY

4/5
82% would recommend190 patient surveys

Hospital ratings are based on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey data published by CMS.

Why ER Visit (Moderate) Visit Costs Vary Across Kentucky

Kentucky's emergency care costs run approximately 5% below national averages, reflecting the state's lower overall healthcare spending and significant rural hospital presence. The Commonwealth's mix of academic medical centers, community hospitals, and critical access hospitals creates distinct pricing tiers across different regions.

Urban vs. Rural Provider Availability

Louisville and Lexington metropolitan areas concentrate the majority of Kentucky's emergency medicine specialists and trauma centers, while rural Appalachian counties rely heavily on critical access hospitals with limited specialist coverage. Eastern Kentucky's mountainous terrain and sparse population create access challenges that drive patients to larger facilities, often resulting in higher transport and facility costs. The urban-rural divide significantly impacts both availability and pricing for emergency services.

Facility Type and Overhead Costs

Hospital-based emergency departments in Kentucky range from Level I trauma centers like the University of Louisville Hospital to small critical access hospitals serving rural communities. Academic medical centers maintain higher overhead costs due to teaching responsibilities, research activities, and complex case loads, while rural hospitals operate with lower staffing costs but higher per-patient fixed expenses. Baptist Health, UK HealthCare, and Norton Healthcare dominate the hospital landscape with varying pricing structures.

Insurance Market Competition in Kentucky

Anthem Blue Cross Blue Shield holds the largest market share in Kentucky, followed by UnitedHealthcare and Humana, creating moderate competition that helps control negotiated rates for emergency services. Rural counties often have limited insurer participation in marketplace plans, reducing competitive pressure on pricing. The state's insurance commissioner actively monitors emergency billing practices, particularly around surprise billing issues.

Physician Supply and Demand in Kentucky

With 405 active providers reporting ER Visit (Moderate) rates, Kentucky maintains adequate emergency medicine coverage in urban areas but faces shortages in rural regions. The physician supply indicates reasonable availability relative to the state's population, though geographic distribution remains uneven. Rural hospital emergency departments often rely on contract physicians or telemedicine support, which can affect both care delivery and pricing structures.

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Jayant Panwar

CEO, Momentary Labs · San Francisco, CA

Jayant has analyzed healthcare pricing data from CMS Transparency in Coverage files since 2022, covering more than 50 million negotiated rate records across all 50 states. His work focuses on making insurer machine-readable files accessible to patients and researchers.

The cost figures on this page reflect his ongoing work to make this data accessible to patients.

Healthcare Data AnalyticsCMS TiC DataInsurance Price Transparency

Frequently Asked Questions — ER Visit (Moderate) Costs in Kentucky

What is the average cost of a ER Visit (Moderate) visit in Kentucky without insurance?

Without insurance, a moderate emergency visit in Kentucky typically costs between $70 and $246, with a median cost of $103 based on negotiated rates from 405 providers statewide. These costs reflect facility fees and physician charges but may not include additional services like diagnostic imaging, laboratory tests, or medications. Rural hospitals often offer more generous self-pay discounts and charity care programs compared to urban medical centers. Many Kentucky hospitals provide payment plans and financial assistance to help uninsured patients manage emergency care costs.

Does Kentucky Medicaid cover ER Visit (Moderate) visits?

Yes, Kentucky's expanded Medicaid program covers emergency department visits with minimal copays, typically $3-5 for most emergency services. Medicaid expansion in Kentucky has provided coverage to over 600,000 adults up to 138% of the federal poverty level, significantly reducing uncompensated emergency care costs. Prior authorization is generally not required for emergency visits, though follow-up specialty care may require approval. Emergency Medicaid also covers undocumented immigrants for emergency conditions regardless of immigration status.

How do I find an affordable ER Visit (Moderate) near me in Kentucky?

Compare costs between different hospital emergency departments in your area, as prices can vary significantly between academic medical centers and community hospitals. Ask about self-pay discounts if you're uninsured, as Kentucky hospitals often offer 25-50% reductions for cash payment. Consider urgent care centers for non-life-threatening conditions, which typically cost $100-300 compared to $500-2000+ for emergency visits. Community health centers throughout Kentucky also provide urgent care services on a sliding fee scale based on income.

What is the difference in cost between an initial consultation and a follow-up visit?

Emergency department visits are typically billed at the same rate regardless of whether it's your first visit or a return visit for the same condition, with moderate visits averaging $103 in Kentucky. The billing level depends on the complexity and resources required during that specific visit rather than visit frequency. However, if your follow-up care can be handled in an outpatient clinic setting, specialty follow-up visits typically cost $200-400 for new patients and $150-250 for established patients. Emergency departments should only be used for follow-up care when urgent complications arise.

Can I use an HSA or FSA to pay for a ER Visit (Moderate) visit in Kentucky?

Yes, emergency department visits are qualified medical expenses that can be paid for using Health Savings Account (HSA) or Flexible Spending Account (FSA) funds. This includes facility fees, physician charges, and any diagnostic tests or treatments received during your emergency visit. Keep all receipts and explanation of benefits forms for your records, as you may need them for tax purposes or FSA reimbursement. HSA funds can be used tax-free for emergency care, making them an excellent way to manage unexpected medical expenses.

How does telemedicine affect the cost of seeing a ER Visit (Moderate) in Kentucky?

Telemedicine cannot replace in-person emergency care for moderate to severe conditions requiring immediate hands-on evaluation and treatment. However, telehealth consultations ($50-150) can help determine whether your symptoms warrant emergency care or can be managed through urgent care or primary care visits. Some Kentucky health systems offer virtual triage services to help patients decide the appropriate level of care needed. While telemedicine has expanded throughout Kentucky since 2020, emergency conditions requiring diagnostic testing, procedures, or immediate intervention still require in-person emergency department visits.

Click a state to compare costs

Average Visit Cost

$82
$311

Office visit (CPT 99284)

Compare With Other States

RankStateAverage↓
1Wisconsin
Range: $73 – $647
$311
2Illinois
Range: $80 – $431
$223
3Iowa
Range: $80 – $371
$205
4New Hampshire
Range: $102 – $307
$202
5Pennsylvania
Range: $55 – $431
$191
6New York
Range: $67 – $374
$183
7Rhode Island
Range: $62 – $374
$177
8Maine
Range: $116 – $233
$172
9Massachusetts
Range: $62 – $368
$170
10Nebraska
Range: $83 – $291
$165
11Washington
Range: $80 – $259
$161
12Michigan
Range: $80 – $291
$158
13New Mexico
Range: $85 – $266
$158
14Wyoming
Range: $85 – $262
$157
15Colorado
Range: $80 – $267
$157
16Vermont
Range: $80 – $257
$156
17Georgia
Range: $84 – $246
$151
18California
Range: $80 – $258
$142
19Indiana
Range: $80 – $258
$142
20Kentucky
Range: $70 – $246
$140
21North Carolina
Range: $80 – $231
$139
22District of Columbia
Range: $80 – $217
$138
23West Virginia
Range: $62 – $174
$137
24Utah
Range: $80 – $228
$135
25Maryland
Range: $80 – $206
$132
26New Jersey
Range: $60 – $237
$131
27Hawaii
Range: $80 – $217
$130
28Arkansas
Range: $80 – $194
$130
29Virginia
Range: $81 – $202
$129
30Tennessee
Range: $85 – $187
$128
31South Carolina
Range: $80 – $206
$128
32Ohio
Range: $75 – $197
$127
33Missouri
Range: $85 – $167
$124
34Alabama
Range: $80 – $195
$124
35Oklahoma
Range: $85 – $169
$123
36Kansas
Range: $86 – $167
$123
37Texas
Range: $80 – $196
$122
38Arizona
Range: $80 – $187
$122
39Mississippi
Range: $86 – $165
$121
40Idaho
Range: $80 – $194
$121
41Delaware
Range: $80 – $157
$120
42Minnesota
Range: $62 – $233
$119
43Nevada
Range: $84 – $184
$119
44Connecticut
Range: $55 – $211
$118
45Alaska
Range: $80 – $194
$118
46Louisiana
Range: $62 – $150
$104
47Oregon
Range: $62 – $183
$102
48Montana
Range: $62 – $145
$96
49Florida
Range: $35 – $190
$95
50North Dakota
Range: $62 – $121
$82
51South Dakota
Range: $62 – $121
$82
ER Visit (Moderate Severity) in Other States
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming