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Ohio rates for HCPCS G0380

Level 1 hospital emergency department visit provided in a type B emergency department; (the ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or emergency department; (2) it is held out to the public (by name, posted signs, advertising, or other means) as a place that provides care for emergency medical conditions on an urgent basis without requiring a previously scheduled appointment; or (3) during the calendar year immediately preceding the calendar year in which a determination under 42 CFR 489.24 is being made, based on a representative sample of patient visits that occurred during that calendar year, it provides at least one-third of all of its outpatient visits for the treatment of emergency medical conditions on an urgent basis without requiring a previously scheduled appointment)

Facilitymedian $65 · 10th–90th $65–$2140%20%40%90th$65Professionalmedian $145 · 10th–90th $17–$2340%20%40%10th90th$145$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $234.42 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.60 / $19.05 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $43.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $60.26
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $75.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $213.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42