go back

Emergency Department Visit, Level 5 (Highest)

South Dakota 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?

$166

Typical physician fee. In South Dakota, July 2026.

Insurers have agreed to pay about $166 for this service. Most negotiated rates run $158 to $389.

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 $251 · 10th to 90th $182 to $324Professionalmedian $166 · 10th to 90th $138 to $692
$50.0$100.0$200.0$500.0$1.0Kfacility $251professional $166

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
$138.04
Median
$165.96
Typical High
$691.83
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$141.25
Median
$407.38
Typical High
$1,819.70
Avera
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$229.09
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$309.03
Typical High
$380.19
Medica
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$251.19
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$316.23
Typical High
$1,096.48
Medica
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$302.00
Median
$302.00
Typical High
$354.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$346.74
Midlands
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$380.19
Typical High
$380.19
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$288.40
Typical High
$338.84
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$288.40
Typical High
$389.05
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$295.12
Typical High
$302.00

Where South Dakota 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.

South Dakota $166 · 40th 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.