There Is No Price: What Four Florida ERs Charge for the Exact Same Visit

01The same visit, four different 'prices'

Since 2021, federal rules have required every hospital to publish a machine-readable file listing its standard charges -- the list price, the cash price, and the rates it has negotiated with each insurer -- for the services it provides. We opened those files for four of Florida's biggest hospitals and looked up a single line: CPT 99285, the facility fee for the highest-level emergency room visit. It is the same code, meaning the same category of care, at every hospital. The list price was not the same anywhere.

This is just the facility fee -- the charge for walking in and being seen at that acuity level, before a single X-ray, CT scan, lab, stitch, or splint is added. For the identical code, Lee Memorial's list price ($6,712) is more than double Baptist Miami's ($2,912). Nobody negotiated this; these are the numbers the hospitals themselves posted. And the list price, it turns out, is the number almost nobody actually pays -- except, sometimes, the person least able to.

02What insurers actually pay is a different world

The same files list what each hospital has agreed to accept from each insurance plan for that exact code. If the list price is fiction, this is supposed to be the real economy. It is just as chaotic.

For the identical ER visit code, insurers pay a median of $3,933 at Lee Memorial and $678 at Tampa General -- nearly six times more for the same line on the same kind of bill, 130 miles apart.

It gets stranger inside a single building. At Sarasota Memorial, the negotiated price for this one code ranges from $140 to $6,211 across the hospital's plans -- a 44-fold spread for the exact same visit, depending only on which insurer's logo is on your card. At Baptist Miami the spread is 17-fold. The 'price' of an ER visit is not a number; it is a different number for every person who walks through the door.

03Cash or insurance? The answer flips by hospital

Hospitals also post a 'discounted cash price' -- what they'll take from someone paying out of pocket, no insurance involved. Conventional wisdom says insurance always beats cash. In these files, it depends entirely on where you are.

The same high-level ER visit (CPT 99285) facility fee at four Florida hospitals: list charge, cash price, and the range insurers pay. From each hospital's public price-transparency file.

At Lee Memorial, the cash price ($1,342) is lower than every single insurer's negotiated rate -- an uninsured patient who asks for the cash price pays less than any insured one. At Tampa General it is the reverse: the cash price ($1,766) is higher than every insurer rate, so running it through insurance always wins. At Sarasota and Baptist the cash price sits in the middle of the pack. There is no rule of thumb that survives contact with the actual data -- which is exactly why, after a crash, you should never assume a bill is correct or that one way of paying is automatically cheaper.

04The number that lands on you

If almost nobody pays the list price, why does it matter? Because after a crash, the list price is the number that can follow you -- through your $10,000 of PIP, and onto a hospital lien.

Florida's no-fault system gives most drivers $10,000 in Personal Injury Protection (PIP) to cover early medical care. A single high-level ER visit facility fee can be up to $6,712 before any imaging or treatment -- and a serious crash workup with a CT scan, X-rays, and labs stacks on top of that. PIP is often gone before you leave the building. What comes next is billed against you, your health insurer, or -- if someone else was at fault and you have a claim -- a hospital lien that attaches to your eventual settlement at the full chargemaster rate, the fictional number nobody else pays.

The list charge is the one price no insurer accepts -- and the one a hospital lien can attach to your crash settlement. Whether that number gets reduced to what care actually costs is often the difference between a fair recovery and a paper one.

This is the same lesson the rest of this project keeps finding in a new place: the number on the bill is not the number the care is worth, and the gap is where your recovery quietly disappears. A hospital that will accept $1,342 in cash or $678 from an insurer for a visit can still lien your settlement for $6,712 -- unless that charge is challenged and reduced to a reasonable amount, which Florida law allows.

05Even Medicare's data shows the markup

The hospital files show prices differ wildly. Medicare's own payment data shows how far the list price floats above the cost of care. Both point the same way.

In Medicare's outpatient hospital data, the average Florida high-acuity emergency visit -- counting everything bundled into it -- is billed at roughly $29,000, while Medicare pays about $2,500 for the same care: a markup of about twelve to one. Medicare's rate is set to approximate the actual cost of providing the service. Private insurers pay somewhere in between, negotiated plan by plan, which is why the hospital files are so scattered. The one constant is that the list price -- the number a crash victim without coverage, or with a lien, is asked to pay -- sits far above what the care costs anyone else.

06Pay more and wait longer: where the price meets the clock

Line these prices up against our companion report on Florida ER wait times and the intuition breaks completely: a longer line does not buy you a cheaper visit. Two of the four hospitals here sit on the state's list of the twelve longest ER waits -- and they land at opposite ends of the price scale.

Tampa General and Lee Memorial both rank among Florida's twelve longest ER waits -- yet insurers pay a median of $678 for the visit at one and $3,933 at the other. Waiting longer buys you nothing on the bill; at some hospitals you pay more and wait longer at once.

It is tempting to assume the slowest ERs are the crowded, bare-bones, cheap ones and the fast ERs charge a premium. The two public datasets say otherwise. Tampa General is both slow and the cheapest hospital here for this code; Lee Memorial is both slow and the most expensive. Cost and crowding are set by different machinery -- ownership, insurer contracts, and case mix -- and a patient can land on the wrong side of both at the same door. The caveat that governs this whole report applies double here: it is one billing code at a handful of hospitals, compared against hospital-wide median wait times, so read it as an illustration of how loosely price and speed are related, not a hospital scorecard.

07What this can and can't tell you

This is a data-journalism analysis of public records. It shows how Florida hospital pricing works using one comparable line item; it is not a price quote or a ranking of hospitals.

• Sources: the hospital standard-charge (price-transparency) files published under 45 CFR 180, downloaded from four Florida hospitals' own websites (April 2026 files), plus CMS 'Medicare Outpatient Hospitals - by Provider/Geography and Service' for the Medicare comparison.
• One code, one line. We compare CPT 99285 -- the facility fee for the highest-level ER visit -- as a like-for-like window. It is not your whole bill: imaging, labs, procedures, and physician fees are billed separately and vary just as much.
• Four hospitals, not all of Florida. We read Lee Memorial, Tampa General, Sarasota Memorial, and Baptist Hospital of Miami -- large systems whose files posted a clean facility fee for this code. Other hospitals will differ; this is an illustration of how pricing works, not a statewide average.
• List, cash, and negotiated prices come straight from each hospital's file; the number of plans behind each hospital's negotiated range varies (18 to 159), so ranges reflect what each hospital chose to disclose.
• Aggregate patterns from public records about hospitals and insurers -- institutions, not individuals. No patient is identified, and none of this is medical or legal advice.

If you were hurt in a crash, get the care you need first -- the 14-day PIP window is real and missing it can cost you coverage. Then, when the bills come, know that the biggest number on them is usually the softest. The tools below help you see what a fair claim looks like and what you actually keep after medical bills and liens.