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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 July 2026.

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

$186

Typical physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $186 for this service. Most negotiated rates run $166 to $251.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $5,370 · 10th to 90th $5,370 to $5,370Professionalmedian $186 · 10th to 90th $145 to $794
$200$500$1K$2K$5Kfacility $5,370professional $186

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
$144.54
Median
$181.97
Typical High
$794.33
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$575.44
Median
$630.96
Typical High
$912.01
BCBS
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$275.42
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$5,370.32
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$208.93
Typical High
$346.74
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$223.87
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$223.87
Typical High
$426.58

Where Vermont sits

The same service costs 2.5 times more in West Virginia than in Delaware. 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.

Vermont· 16th of 51

$186

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.