Emergency · procedure code 99285
ER visit, severe cost in Houston, TX
What health plans have contracted to pay providers for Emergency department visit, high severity in the Houston-Pasadena-The Woodlands market, from the machine-readable files those plans publish under federal law. Not billed charges, and not an estimate.
Metro market
ER visit, severe
Houston-Pasadena-The Woodlands, TX · procedure code 99285
Middle price
$210
Half of this market is above it, half below
Middle half spans
$162 to $267
1.6x from low to high
The expensive end
$428
What the priciest providers charge
Medicare reference · Rest Of Texas (nearest published locality)
$169
Performed in an office
Negotiated prices from published filings, reported only where the sample supports it. For your city, not a statewide average. What plans have agreed to pay, not what a patient is billed. Filings as of July 20, 2026.
Reading it
What this distribution actually says.
The spread
The middle half of this market runs from $162 to $267, a 1.6x difference for the same procedure code in the same city. That gap is between contracts, not between quality.
Against Medicare
The middle price sits at 124% of what Medicare pays for the same service at its Rest Of Texas locality. Medicare is a fixed reference line most finance teams already have a feel for, which is why we print it beside every figure. It is not a fair price and not what anything should cost.
The expensive end
One in ten filings sits at or above $428. If a plan's network is weighted toward that end, the difference does not show up in a premium quote. It shows up in the claims.
How wide the data runs
The carriers that filed for this procedure in this market. What each plan has agreed to pay, side by side. These are prices, not bills, so they do not show how often anyone needs it.
The same service elsewhere
ER visit, severe across other markets.
Of the 6 markets compared here, Houston, TX has the 1st highest middle price.
Put this in front of a client.
Every figure on this page carries its source, its scope and the date the corpus was built, so it survives being forwarded to someone who was not in the meeting.