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 | $631.14 | |
BCBS
| Facility | $377.64 | $377.64 | $3,315.78 | |
BCBS
| Professional | $358.76 | $396.52 | $509.81 | |
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Health Alliance Plan
| Professional | $291.48 | $291.48 | $453.40 | |
Molina
| Professional | $30.00 | $30.00 | $55.00 | |
United
| Facility | $294.42 | $294.42 | $1,136.90 |