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Emergency Department Visit, Level 5 (Highest)

Illinois 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?

$195

Typical physician fee. In Illinois, July 2026.

Insurers have agreed to pay about $195 for this service. Most negotiated rates run $151 to $537.

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 7 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $741 · 10th to 90th $355 to $933Professionalmedian $195 · 10th to 90th $117 to $1,000
$10.0$20.0$50.0$100.0$200.0$500.0$1.0Kfacility $741professional $195

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
$114.82
Median
$186.21
Typical High
$1,023.29
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$338.84
Typical High
$912.01
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$354.81
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$141.25
Median
$173.78
Typical High
$288.40
BCBS
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$741.31
Typical High
$891.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$234.42
Typical High
$251.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$239.88
Typical High
$371.54
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$398.11
Typical High
$1,348.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,412.54
United
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$275.42
Typical High
$645.65
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$371.54

Where Illinois 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.

Illinois $195 · 8th 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.