Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
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)
Low
$169
Average
$340
Median
$257
High
$1.8k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 1.3× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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27 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Ascension Seton Austin, TX fee schedule · outpatient | 1 | $190 | $190 | — | — | — | $190 – $190 |
| 2 | Beaufort Memorial Hospital Beaufort, SC facility · case rate · outpatient | 1 | $281 | $281 | — | — | — | $281 – $281 |
| 3 | Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · case rate · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 4 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $257 | $257 | — | — | — | $257 – $257 |
| 5 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $257 | $257 | — | — | — | $257 – $257 |
| 6 | Charleston Area Medical Center Charleston, WV percent of total billed charges · outpatientfrom % of charges | 1 | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 7 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 8 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 9 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 10 | Gerald Champion Regional Medical Center Alamogordo, NM fee schedule · outpatient | 5 | $281 | $281 | — | — | — | $281 – $281 |
| 11 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $280 | $280 | — | — | — | $280 – $280 |
| 12 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital City, UT facility · case rate · outpatient | 1 | $274 | $274 | — | — | — | $274 – $274 |
| 13 | IHC Health Services Inc., DBA Intermountain Primary Children's Hospital Lehi, UT facility · case rate · outpatient | 1 | $274 | $274 | — | — | — | $274 – $274 |
| 14 | LECONTE MEDICAL CENTER Sevierville, TN fee schedule · outpatient | 1 | $257 | $257 | — | — | — | $257 – $257 |
| 15 | Little Company of Mary Hospital of Indiana Inc Jasper, IN facility · case rate · outpatient | 1 | $254 | $254 | — | — | — | $254 – $254 |
| 16 | METHODIST MEDICAL CENTER OF OAK RIDGE Oak Ridge, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 17 | MORRISTOWN HAMBLEN HOSPITAL ASSOCIATION Morristown, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 18 | Mercy Hospital Lincoln Troy, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $169 | $169 | — | — | — | $169 – $169 |
| 19 | NATIONWIDE CHILDREN'S HOSPITAL TOLEDO, LLC Toledo, OH facility · fee schedule · outpatient | 1 | $271 | $271 | — | — | — | $271 – $271 |
| 20 | Nationwide Children's Hospital Columbus, OH facility · fee schedule · outpatient | 1 | $271 | $271 | — | — | — | $271 – $271 |
| 21 | PARKWEST MEDICAL CENTER Knoxville, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 22 | PARKWEST MEDICAL CENTER Louisville, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 23 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · outpatient | 1 | $315 | $315 | — | — | — | $315 – $315 |
| 24 | ROANE COUNTY MEDICAL CENTER Harriman, TN fee schedule · outpatient | 1 | $240 | $240 | — | — | — | $240 – $240 |
| 25 | STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER JACKSON, MS other · outpatient | 1 | $239 | $239 | — | — | — | $239 – $239 |
← Payers reporting HCPCS G0383 · Snapshot 20261111T120946Z-9134e7f7