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 | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $229.09 | $234.42 | $302.00 | |
Anthem BCBS
| Professional | $95.50 | $109.65 | $173.78 | |
Cigna
| Facility | $64.57 | $64.57 | $64.57 | |
Cigna
| Professional | $676.08 | $676.08 | $676.08 | |
Medical Mutual of Ohio
| Facility | $64.57 | $64.57 | $64.57 | |
Medical Mutual of Ohio
| Professional | $676.08 | $676.08 | $676.08 | |
Molina
| Professional | $32.36 | $50.12 | $60.26 | |
SummaCare
| Professional | $60.26 | $70.79 | $75.86 | |
United
| Facility | $758.58 | $758.58 | $758.58 |