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Washington 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
$1,715.08 / $1,715.08 / $2,257.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.05 / $232.96 / $381.33
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.21 / $727.12 / $727.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.46 / $681.46 / $681.46
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.55 / $679.03 / $1,318.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$445.00 / $713.00 / $79,999.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $250.00 / $250.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.97 / $94.97 / $94.97