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Idaho 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
$249.32 / $249.32 / $249.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.96 / $232.96 / $249.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.46 / $681.46 / $681.46
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.96 / $244.61 / $300.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.36 / $515.36 / $515.36