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Emergency Department Visit, Level 5 (Highest)

Florida 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?

$170

Typical physician fee. In Florida, July 2026.

Insurers have agreed to pay about $170 for this service. Most negotiated rates run $141 to $229.

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 8 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,455 · 10th to 90th $1,122 to $4,074Professionalmedian $170 · 10th to 90th $123 to $372
$10.0$50.0$200.0$1.0K$5.0Kfacility $2,455professional $170

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. Small sample; interpret with caution. 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
$169.82
Typical High
$380.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$87.10
Median
$467.74
Typical High
$933.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$630.96
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$147.91
Median
$190.55
Typical High
$616.60
AvMed
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$181.97
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$4,168.69
Typical High
$4,570.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$478.63
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$2,187.76
Typical High
$4,073.80
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$162.18
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$36.31
Typical High
$302.00
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$398.11
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$70.79
Median
$85.11
Typical High
$245.47
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$181.97

Where Florida 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.

Florida $170 · 34th 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.