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Emergency Department Visit, Level 5 (Highest)

Idaho 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?

$436

Typical total for the visit. In Idaho, July 2026.

Insurers have agreed to pay about $436 for this emergency department visit. That total is two separate charges billed under the same code: $191 to the emergency physician who treats you, and $245 to the hospital for the emergency department itself. Tests, imaging and treatments during the visit are billed separately.

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.

What's inside this number

Part of the billTypicalRange
Physician feeThe emergency physician who treats you$191$155 to $347
Facility feeThe hospital emergency department$245$200 to $309

How much rates vary

Facilitymedian $245 · 10th to 90th $174 to $468Professionalmedian $191 · 10th to 90th $117 to $617
$50.0$100.0$200.0$500.0$1.0Kfacility $245professional $191

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
$100.00
Median
$186.21
Typical High
$630.96
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$169.82
Median
$575.44
Typical High
$660.69
BCBS
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$794.33
Typical High
$1,288.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$338.84
Typical High
$354.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$234.42
Typical High
$389.05
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$245.47
Typical High
$398.11
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$302.00
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$1,288.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$263.03
Typical High
$338.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$239.88
Typical High
$346.74
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$245.47
Median
$245.47
Typical High
$245.47

Where Idaho sits

The same service costs 18.8 times more in Vermont than in New Hampshire. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Physician feeFacility feeIdaho $436 · 19th of 43
VT $5,557NH $295

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.