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Emergency Department Visit, Level 5 (Highest)

Kentucky 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 Kentucky, July 2026.

Insurers have agreed to pay about $174 for this service. Most negotiated rates run $138 to $288.

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 $182 · 10th to 90th $155 to $240Professionalmedian $174 · 10th to 90th $115 to $832
$50.0$100.0$200.0$500.0$1.0K$2.0Kfacility $182professional $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. 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
$173.78
Typical High
$912.01
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$316.23
Typical High
$660.69
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$199.53
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$141.25
Median
$165.96
Typical High
$234.42
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$269.15
CareSource
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$181.97
Typical High
$239.88
CareSource
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$194.98
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$245.47
Typical High
$831.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$181.97
Typical High
$389.05
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$89.13

Where Kentucky 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.

Kentucky $174 · 32nd 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.