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Emergency Department Visit, Level 5 (Highest)

Texas 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?

$385

Typical total for the visit. In Texas, July 2026.

Insurers have agreed to pay about $385 for this emergency department visit. That total is two separate charges billed under the same code: $166 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 13 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe emergency physician who treats you$166$141 to $191
Facility feeThe hospital emergency department$219$182 to $347

How much rates vary

Facilitymedian $219 · 10th to 90th $166 to $617Professionalmedian $166 · 10th to 90th $135 to $302
$10.0$100.0$1.0K$10.0Kfacility $219professional $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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$162.18
Typical High
$288.40
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$389.05
Typical High
$630.96
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$251.19
Typical High
$537.03
Ambetter
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$158.49
Median
$257.04
Typical High
$537.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$2,511.89
Typical High
$7,244.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$158.49
Typical High
$190.55
Baylor Scott & White
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$346.74
Typical High
$2,041.74
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$229.09
Typical High
$501.19
Christus
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$457.09
Typical High
$457.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$1,318.26
Typical High
$1,479.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$218.78
Typical High
$389.05
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$1,096.48
Typical High
$1,096.48
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$691.83
Typical High
$1,096.48
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$213.80
Typical High
$478.63
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$251.19
Typical High
$316.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$117.49
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$316.23
Typical High
$407.38
Providence
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$213.80
Typical High
$501.19
Providence
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$218.78
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$186.21
Typical High
$354.81
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$89.13
Median
$89.13
Typical High
$245.47
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$165.96
Typical High
$234.42

Where Texas 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 feeTexas $385 · 33rd 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.