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Emergency Department Visit, Level 5 (Highest)

Maine 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?

$1,322

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

Insurers have agreed to pay about $1,322 for this emergency department visit. That total is two separate charges billed under the same code: $174 to the emergency physician who treats you, and $1,148 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe emergency physician who treats you$174$148 to $214
Facility feeThe hospital emergency department$1,148$832 to $1,950

How much rates vary

Facilitymedian $1,148 · 10th to 90th $794 to $4,266Professionalmedian $174 · 10th to 90th $138 to $324
$100.0$500.0$2.0K$10.0Kfacility $1,148professional $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
$134.90
Median
$154.88
Typical High
$190.55
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$257.04
Typical High
$389.05
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$223.87
Typical High
$371.54
Community Health Options
Setting
Facility
Modifier
Global
Typical Low
$4,265.80
Median
$4,265.80
Typical High
$4,265.80
Community Health Options
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$263.03
Typical High
$354.81
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$295.12
Typical High
$478.63
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$831.76
Typical High
$1,949.84
Martin's Point
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$954.99
Median
$954.99
Typical High
$977.24
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$257.04
Typical High
$380.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$75.86
Median
$75.86
Typical High
$89.13

Where Maine 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 feeMaine $1,322 · 6th 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.