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Washington 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.02 / $442.02 / $579.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.00 / $232.54 / $232.54
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.43 / $220.72 / $220.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.50 / $43.50 / $43.50
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.14 / $166.44 / $428.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.00 / $182.00 / $79,999.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.07 / $16.07 / $16.07