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Arizona 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
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $631.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$421.45 / $716.46 / $716.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.80 / $559.78 / $650.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $171.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $631.16 / $757.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.92 / $656.92 / $656.92