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Emergency Department Visit, Level 5 (Highest)

South 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?

$401

Typical total for the visit. In South Carolina, July 2026.

Insurers have agreed to pay about $401 for this emergency department visit. That total is two separate charges billed under the same code: $182 to the emergency physician who treats you, and $219 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$182$145 to $776
Facility feeThe hospital emergency department$219$186 to $295

How much rates vary

Facilitymedian $219 · 10th to 90th $158 to $447Professionalmedian $182 · 10th to 90th $115 to $1,047
$50.0$100.0$200.0$500.0$1.0K$2.0Kfacility $219professional $182

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
$114.82
Median
$181.97
Typical High
$1,071.52
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$165.96
Median
$602.56
Typical High
$1,348.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$204.17
Typical High
$302.00
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$154.88
Median
$245.47
Typical High
$302.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,047.13
Typical High
$1,230.27
BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$194.98
Typical High
$295.12
Medcost
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Medcost
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$213.80
Typical High
$389.05
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$3,981.07
Typical High
$3,981.07
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$169.82
Typical High
$302.00
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$89.13

Where South Carolina 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 feeSouth Carolina $401 · 28th 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.