Texas guide

Freestanding ER vs urgent care in Texas

Texas has more freestanding emergency rooms than almost anywhere, and many sit in the same strip centers as urgent care clinics. They look alike from the parking lot, but they are licensed, staffed and billed very differently. Here’s how to tell them apart and what the law requires.

	Urgent care	Freestanding ER	Hospital ER
Hours	Set hours, often evenings and weekends	24/7 (required for a Texas license)	24/7
Doctor on site	Varies; often physicians, PAs or nurse practitioners	A physician at all times	A physician at all times
Imaging and lab	Many have X-ray and basic lab	X-ray, CT, ultrasound and emergency lab on site	Full hospital services
Billed as	An office or clinic visit	An ER visit, often with a facility fee	An ER visit, often with a facility fee
Average price (Texas, 2015)	$168	$2,199	$2,259
Medicare	Varies by clinic	Not if independent; yes if hospital-run	Yes

Prices are average allowed amounts in Blue Cross Blue Shield of Texas claims from 2015 (Ho et al., 2017). Your cost depends on your plan and the care you receive.

What a freestanding ER is

A freestanding emergency medical care facility is an emergency room that isn’t physically part of a hospital. Texas began licensing them in 2009. To hold a license, a facility must be open 24 hours a day, 7 days a week, keep at least one physician on site whenever it’s open, have a nurse trained in adult and pediatric advanced life support on duty, and have X-ray, CT, ultrasound and an emergency lab available on the premises.

It must also give a medical screening and stabilizing treatment to anyone who comes in, regardless of ability to pay, and keep a transfer agreement with a hospital. As of September 2026, the state listed 212 licensed freestanding ERs. Freestanding ERs owned by a hospital don’t need this license; they operate under the hospital’s license instead, and Texas law still bars them from advertising as anything other than an emergency room.

How to tell them apart

The name. Only licensed or hospital-run emergency facilities may call themselves an emergency room in Texas. If the sign says “ER” or “emergency,” expect ER prices, even if the building looks like a clinic.

The required sign. Since 2019, licensed freestanding ERs must post a notice at the main entrance, in every treatment room, at payment areas and on their website. It has to say the facility is a freestanding emergency facility, that it charges rates comparable to a hospital ER and may charge a facility fee, that the facility or its doctors may be out of network and doctors may bill separately, and which health plans it’s in network with (or that it’s out of network with all of them).

The paperwork. Each patient must get a written disclosure, in English and Spanish, listing the facility’s fees and the plans it’s in network with. A facility can’t say it “takes” or “accepts” your insurance unless it’s actually in network.

The hours. Licensed freestanding ERs are open around the clock. Some hospital-run sites with names like “urgent care emergency center” keep shorter hours but still bill as an ER, so the name matters more than the hours.

What a visit may cost

ER visits usually include a facility fee on top of the doctor’s charge. In large-employer plans in 2021, the average ER facility fee was $713, ranging from about $257 for the least complex visits to $930 for the most complex (Peterson-KFF). In Texas claims from 2015, freestanding and hospital ER visits cost about the same, and nearly ten times urgent care for the same diagnosis; three-quarters of the most common diagnoses were the same at freestanding ERs and urgent care clinics (Ho et al., 2017).

Texas also bans unconscionable pricing at freestanding ERs; prices under twice the county’s average hospital ER price fall within a safe harbor. Complaints go to the Texas Attorney General.

Your surprise-billing protections

Many freestanding ERs are out of network. In 2019 they billed insurers about $833 million out of network, compared with $74 million in network (Texas Department of Insurance). Two laws limit what you owe for emergency care at an out-of-network ER, including a freestanding one:

Texas SB 1264 (care on or after January 1, 2020) covers state-regulated plans and the ERS and TRS plans for state employees and teachers.
The federal No Surprises Act (since January 1, 2022) covers most other private plans and explicitly includes independent freestanding emergency departments.

Under both, you generally owe only your in-network copay, coinsurance and deductible for emergency care. These protections don’t cover people paying on their own without insurance, and some plan types (such as short-term plans and health-care sharing ministries) aren’t included. After you’re stable, read any form asking you to give up these protections before you sign it.

Questions about a bill: the Texas Department of Insurance at 800-252-3439, or the federal No Surprises Help Desk at 1-800-985-3059.

Medicare and freestanding ERs

Independent freestanding ERs aren’t eligible for Medicare payment. Freestanding ERs run by a hospital bill Medicare as part of that hospital. Many ER.com listings note when a hospital system runs a freestanding ER.

If you think it may be an emergency

Cost and network rules should never keep you from emergency care. If you think something may be an emergency, go to the nearest ER or call 911. Billing questions can be sorted out later, and the protections above apply.

Common questions

Freestanding ERs, answered.

Is a freestanding ER a real emergency room?

Yes. In Texas a licensed freestanding emergency medical care facility must be open 24/7, have a physician on site at all times, and have X-ray, CT, ultrasound and an emergency lab available. It bills like an ER.

Can a Texas freestanding ER turn me away if I can’t pay?

Texas law requires licensed freestanding ERs to provide a medical screening and stabilizing treatment without regard to a person’s ability to pay, and to have a transfer agreement with a hospital.

Is a freestanding ER cheaper than a hospital ER?

Not usually. In Blue Cross Blue Shield of Texas claims from 2015, the average freestanding ER visit cost $2,199 and the average hospital ER visit $2,259, compared with $168 at urgent care.

Will my insurance cover a freestanding ER?

Many Texas freestanding ERs are out of network. For emergency care, Texas law (since 2020, for state-regulated plans) and the federal No Surprises Act (since 2022) generally limit what you owe to your in-network copay, coinsurance and deductible. Each facility must post which plans it’s in network with.

Does Medicare cover freestanding ERs?

Independent freestanding ERs aren’t eligible for Medicare payment. Freestanding ERs run by a hospital bill Medicare as part of that hospital. If you have Medicare, check whether a freestanding ER is hospital-run.

Find care nearby

Each city page labels every listing as urgent care, freestanding ER or hospital ER: San Antonio, Boerne and Fair Oaks Ranch.

Sources

Last updated October 25, 2026. General information about Texas law and costs, not legal or medical advice. How our listings work.

This is not for emergencies.

For life-threatening symptoms, severe chest pain, trouble breathing, or immediate danger, call 911 or go to the nearest emergency department.