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Nationwide rates for HCPCS G0383

Level 4 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	Facility/Professional	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $232.96 / $232.96 / $241.14	Facility	$232.96	$232.96	$241.14
Aetna Facility/Professional Professional Modifier Low / Median / High Price $231.05 / $232.96 / $249.32	Professional	$231.05	$232.96	$249.32
BCBS Facility/Professional Facility Modifier Low / Median / High Price $1,225.00 / $2,200.00 / $2,711.00	Facility	$1,225.00	$2,200.00	$2,711.00
BCBS Facility/Professional Professional Modifier Low / Median / High Price $81.18 / $94.72 / $131.13	Professional	$81.18	$94.72	$131.13
Cigna Facility/Professional Facility Modifier Low / Median / High Price $64.00 / $64.00 / $64.00	Facility	$64.00	$64.00	$64.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $681.46 / $681.46 / $681.46	Professional	$681.46	$681.46	$681.46

Nationwide rates for HCPCS G0383

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