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Wisconsin 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
Facility
Modifier
Low / Median / High Price
$288.40 / $338.84 / $338.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $288.40 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $147.91 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $436.52 / $436.52
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $549.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $288.40 / $630.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87