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Emergency Department Visit, Level 5 (Highest)

Virginia 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?

$380

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

Insurers have agreed to pay about $380 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 $214 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 8 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 $214
Facility feeThe hospital emergency department$214$182 to $269

How much rates vary

Facilitymedian $214 · 10th to 90th $166 to $363Professionalmedian $166 · 10th to 90th $129 to $309
$10.0$100.0$1.0Kfacility $214professional $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
$123.03
Median
$158.49
Typical High
$275.42
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$169.82
Median
$354.81
Typical High
$575.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$234.42
Typical High
$426.58
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$204.17
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$213.80
Typical High
$389.05
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$204.17
Typical High
$602.56
Medcost
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$194.98
Typical High
$323.59
Medcost
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$223.87
Typical High
$407.38
Medcost
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
Sentara
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$199.53
Typical High
$338.84
Sentara
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$199.53
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$2,754.23
Typical High
$2,754.23
United
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$194.98
Typical High
$380.19
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$79.43
Median
$89.13
Typical High
$371.54

Where Virginia 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 feeVirginia $380 · 35th 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.