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Ohio rates for HCPCS G0384

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
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.48 / $291.48 / $862.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.88 / $166.72 / $283.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.98 / $366.98 / $1,825.09
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.98 / $366.98 / $366.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.20 / $1,105.20 / $1,132.38