Level 5 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 | $291.48 | $291.48 | $291.48 | |
Aetna
| Professional | $195.58 | $291.48 | $513.13 | |
BCBS
| Facility | $1,225.00 | $2,486.30 | $2,736.80 | |
BCBS
| Professional | $126.47 | $148.41 | $205.17 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $744.89 | $1,215.31 | $1,825.09 | |
United
| Facility | $1,082.55 | $1,091.61 | $1,299.97 |
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