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Idaho 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
$631.16 / $631.16 / $631.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $390.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.98 / $12.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $3,500.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,416.84 / $1,416.84 / $1,416.84