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Emergency Department Visit, Level 5 (Highest)

North Carolina 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?

$186

Typical physician fee. In North Carolina, July 2026.

Insurers have agreed to pay about $186 for this service. Most negotiated rates run $148 to $309.

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.

How much rates vary

Facilitymedian $224 · 10th to 90th $170 to $389Professionalmedian $186 · 10th to 90th $129 to $417
$50.0$100.0$200.0$500.0$1.0K$2.0Kfacility $224professional $186

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
$123.03
Median
$165.96
Typical High
$426.58
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$199.53
Median
$537.03
Typical High
$2,187.76
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$234.42
Typical High
$380.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$239.88
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$309.03
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$229.09
Typical High
$426.58
Medcost
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Medcost
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$371.54
Medcost
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$426.58
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$295.12
Typical High
$407.38
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$181.97
Typical High
$380.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$245.47
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48

Where North Carolina 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.

North Carolina $186 · 12th 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.