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Emergency Department Visit, Level 5 (Highest)

Washington, DC rates for HCPCS 99285

An emergency department visit involving a patient history and physical examination, with high-complexity medical decision-making. This is the highest of the five visit levels, one step above the moderate-complexity level. The extent of the history and examination is whatever is medically appropriate.

Rates data updated July 2026.

How much does Emergency Department Visit, Level 5 (Highest) cost?

$158

Typical physician fee. In Washington, DC, July 2026.

Insurers have agreed to pay about $158 for this service. Most negotiated rates run $138 to $186.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $158 · 10th to 90th $123 to $214
$50.0$100.0$200.0$500.0$1.0K$2.0Kprofessional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$154.88
Typical High
$208.93
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$95.50
Median
$186.21
Typical High
$263.03
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$194.98
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$218.78
Typical High
$676.08
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$239.88
Typical High
$562.34
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$89.13

Where Washington, DC sits

The same service costs 2.5 times more in West Virginia than in Delaware. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Washington, DC $158 · 48th of 51
WV $372DE $148

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.