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Emergency Department Visit, Level 5 (Highest)

Utah 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?

$178

Typical physician fee. In Utah, July 2026.

Insurers have agreed to pay about $178 for this service. Most negotiated rates run $148 to $282.

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 $229 · 10th to 90th $229 to $229Professionalmedian $178 · 10th to 90th $132 to $537
$10.0$20.0$50.0$100.0$200.0$500.0$1.0Kfacility $229professional $178

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
$131.83
Median
$173.78
Typical High
$562.34
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$33.88
Median
$549.54
Typical High
$2,818.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$245.47
Typical High
$501.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$489.78
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$309.03
Typical High
$446.68
Select Health
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Select Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$363.08
Typical High
$489.78
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$251.19
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$199.53
Typical High
$398.11
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$194.98

Where Utah 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.

Utah $178 · 27th 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.