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California 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
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.05 / $231.05 / $7,424.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.05 / $232.96 / $381.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.00 / $2,827.00 / $13,163.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.81 / $94.72 / $95.70
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$310.48 / $310.48 / $310.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.46 / $681.46 / $681.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.26 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.05 / $232.96 / $442.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.46 / $681.46 / $681.46