go back

Wisconsin 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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $234.42 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $95.50 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $234.42 / $380.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $234.42 / $380.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08