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Emergency Department Visit, Level 5 (Highest)

Georgia 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?

$174

Typical physician fee. In Georgia, July 2026.

Insurers have agreed to pay about $174 for this service. Most negotiated rates run $148 to $234.

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 $1,995 · 10th to 90th $229 to $1,995Professionalmedian $174 · 10th to 90th $132 to $813
$10.0$50.0$200.0$1.0Kfacility $1,995professional $174

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
$128.82
Median
$165.96
Typical High
$912.01
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$234.42
Typical High
$794.33
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$295.12
Typical High
$389.05
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$173.78
Median
$295.12
Typical High
$389.05
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$338.84
CareSource
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
CareSource
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$208.93
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$229.09
Typical High
$398.11
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$512.86
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$295.12
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$371.54
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$371.54

Where Georgia 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.

Georgia $174 · 33rd 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.