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Massachusetts 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 / $103.91
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.33 / $1,243.80 / $2,084.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,354.46 / $1,354.46 / $1,354.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $171.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,249.15 / $1,249.15 / $1,491.40
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.92 / $656.92 / $656.92