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
| Facility | $1,715.08 | $2,257.44 | $2,257.44 | |
Aetna
| Professional | $231.05 | $232.96 | $249.32 | |
Cigna
| Professional | $681.46 | $681.46 | $681.46 | |
Moda Health
| Facility | $232.96 | $232.96 | $500.86 | |
Pacific Source
| Facility | $445.00 | $79,999.20 | $79,999.20 | |
Providence
| Facility | $232.96 | $232.96 | $2,400,000.00 | |
Providence
| Professional | $681.46 | $2,250,000.00 | $2,400,000.00 | |
Regence BlueShield
| Facility | $851.19 | $935.74 | $1,001.40 |