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Kentucky 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
$5.81 / $5.81 / $5.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $631.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.28 / $96.80 / $96.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.24 / $473.24 / $473.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $533.75 / $533.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,000.00