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Connecticut 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
$2,478.17 / $2,478.17 / $2,478.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $390.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.80 / $85.07 / $96.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$709.90 / $709.90 / $1,870.23