Spending on ER is calculated as the average per person spending on ER E&M CPT codes (99281 – 99285) for people with employer-sponsored insurance (ESI) and ages 0-64. Average annual ER per person spending is calculated by summing all dollars directly spent on these five ER E&M codes in each year and dividing that amount by the average number of people with ESI (total months of ESI coverage divided by 12). It is not the same as out-of-pocket spending, which is determined by the payments per person paid by patients for health care services (defined as the sum of deductibles, co-payments, and co-insurance amounts). We used the downloadable data from "Ouch!: New Data reveals ER spending increased by 51% from 2012 – 2019, with patient out of pocket payments increasing by 85%" for both figures: Figure 1 uses national spending data from 2016 to 2019, Figure 2 uses state level spending data for 2019. Please see the Report and Methods note document on the HCCI website for more information about the data and methods.

Annual Valentine's Day spending data is from National Retail Federation (NRF)'s Valentine's Day study, state-based data gathered from a study by Finder.com and published in Vox in 2016.