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North Carolina rates for HCPCS G0381

Level 2 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 $132 · 10th–90th $126–$2140%20%40%10th90th$132Professionalmedian $129 · 10th–90th $126–$2510%20%40%10th90th$129$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $125.89 / $151.36
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $37.15 / $37.15
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $131.83 / $213.80
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $524.81 / $630.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $302.00
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00