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Emergency Department Visit, Level 5 (Highest)

West 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?

$372

Typical physician fee. In West Virginia, July 2026.

Insurers have agreed to pay about $372 for this service. Most negotiated rates run $166 to $912.

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 $186 · 10th to 90th $166 to $240Professionalmedian $372 · 10th to 90th $135 to $1,122
$10.0$20.0$50.0$100.0$200.0$500.0$1.0Kfacility $186professional $372

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
$134.90
Median
$371.54
Typical High
$1,122.02
Aetna
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$316.23
Median
$380.19
Typical High
$389.05
CareSource
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$186.21
Typical High
$239.88
CareSource
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$181.97
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$239.88
Typical High
$831.76
Highmark BCBS
Setting
Facility
Modifier
25 · Same-day visit
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$223.87
Typical High
$354.81
Highmark BCBS
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$208.93
Median
$223.87
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$177.83
Typical High
$338.84
United
Setting
Professional
Modifier
25 · Same-day visit
Typical Low
$60.26
Median
$79.43
Typical High
$245.47

Where West Virginia 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.

West Virginia $372 · 1st 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.