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Emergency Department Visit, Level 5 (Highest)

New Jersey 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?

$162

Typical physician fee. In New Jersey, July 2026.

Insurers have agreed to pay about $162 for this service. Most negotiated rates run $138 to $214.

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 $2,291 · 10th to 90th $1,175 to $10,471Professionalmedian $162 · 10th to 90th $123 to $389
$50.0$200.0$1.0K$5.0Kfacility $2,291professional $162

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
$117.49
Median
$158.49
Typical High
$363.08
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$446.68
Typical High
$562.34
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$186.21
Typical High
$501.19
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$144.54
Median
$169.82
Typical High
$446.68
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$6,606.93
Typical High
$10,471.29
AmeriHealth
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$269.15
Typical High
$776.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$467.74
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$288.40
Typical High
$416.87
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,905.46
Typical High
$2,398.83
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$194.98
Typical High
$354.81
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$489.78
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$371.54
Median
$371.54
Typical High
$371.54

Where New Jersey 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.

New Jersey $162 · 46th 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.