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Alaska rates for HCPCS G0257

Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,797.76 / $1,797.76 / $1,797.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $5.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $171.28
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $16.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $16.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,400,000.00 / $2,400,000.00