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Michigan rates for HCPCS G0382

Level 3 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
$242.10 / $242.10 / $242.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.60 / $242.10 / $385.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.46 / $174.46 / $1,531.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.74 / $183.18 / $235.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.20 / $106.20 / $106.20
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.13 / $242.10 / $376.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00