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Emergency Department Visit, Level 5 (Highest)

Vermont 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 October 2026.

How much does Emergency Department Visit, Level 5 (Highest) cost?

$1,780

Typical total for the visit. In Vermont, October 2026.

Insurers have agreed to pay about $1,780 for this emergency department visit. That total is two separate charges billed under the same code: $195 to the emergency physician who treats you, and $1,585 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$195$170 to $240
Facility feeThe hospital emergency department$1,585$912 to $1,862

How much rates vary

Facilitymedian $1,585 · 10th to 90th $562 to $2,042Professionalmedian $195 · 10th to 90th $145 to $275
$200$500$1K$2K$5Kfacility $1,585professional $195

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$562.34
Median
$1,584.89
Typical High
$1,905.46
Aetna
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$165.96
Typical High
$229.09
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$954.99
Median
$954.99
Typical High
$2,691.53
BCBS Vermont
Setting
Facility
Modifier
None
Typical Low
$1,000.00
Median
$1,445.44
Typical High
$2,398.83
BCBS Vermont
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$275.42
Typical High
$275.42
Cigna
Setting
Facility
Modifier
None
Typical Low
$4,570.88
Median
$5,128.61
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$234.42
Health New England
Setting
Facility
Modifier
None
Typical Low
$1,318.26
Median
$1,318.26
Typical High
$2,691.53
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$223.87
Typical High
$239.88
United
Setting
Facility
Modifier
None
Typical Low
$4,786.30
Median
$4,786.30
Typical High
$5,248.07
United
Setting
Professional
Modifier
None
Typical Low
$194.98
Median
$239.88
Typical High
$354.81

Where Vermont sits

The same service costs 9.6 times more in New Hampshire than in Idaho. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Vermont· 31st of 50

$1,780

$195 physician + $1,585 facility

NH $5,599ID $582

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.