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Emergency Department Visit, Level 5 (Highest)

Michigan 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?

$356

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

Insurers have agreed to pay about $356 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 $182 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$174$145 to $240
Facility feeThe hospital emergency department$182$155 to $195

How much rates vary

Facilitymedian $182 · 10th to 90th $138 to $257Professionalmedian $174 · 10th to 90th $132 to $427
$50.0$100.0$200.0$500.0$1.0Kfacility $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
$131.83
Median
$169.82
Typical High
$426.58
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$169.82
Median
$436.52
Typical High
$2,238.72
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$426.58
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$169.82
Typical High
$181.97
BCBS
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$263.03
Typical High
$933.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$281.84
Typical High
$302.00
CareSource
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$194.98
Typical High
$239.88
CareSource
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$199.53
Typical High
$234.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$204.17
Typical High
$707.95
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$173.78
Typical High
$190.55
Health Alliance Plan
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$1,659.59
Median
$1,819.70
Typical High
$7,762.47
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$295.12
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$380.19
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$1,659.59
Typical High
$1,659.59
United
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$223.87
Typical High
$630.96
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$245.47

Where Michigan 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 feeMichigan $356 · 39th 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.