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Emergency Department Visit, Level 5 (Highest)

New Mexico 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?

$433

Typical total for the visit. In New Mexico, July 2026.

Insurers have agreed to pay about $433 for this emergency department visit. That total is two separate charges billed under the same code: $170 to the emergency physician who treats you, and $263 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$170$138 to $191
Facility feeThe hospital emergency department$263$204 to $447

How much rates vary

Facilitymedian $263 · 10th to 90th $166 to $2,455Professionalmedian $170 · 10th to 90th $115 to $275
$10.0$50.0$200.0$1.0Kfacility $263professional $170

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
$112.20
Median
$165.96
Typical High
$251.19
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$162.18
Median
$177.83
Typical High
$1,148.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$169.82
Typical High
$302.00
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$134.90
Median
$169.82
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$1,819.70
Typical High
$2,884.03
BCBS
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$234.42
Typical High
$371.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$257.04
Providence
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$239.88
Typical High
$380.19
Providence
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$257.04
Typical High
$436.52
United
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$2,570.40
Typical High
$2,570.40
United
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$234.42
Typical High
$426.58
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$79.43
Typical High
$89.13

Where New Mexico 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 feeNew Mexico $433 · 21st 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.