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Missouri 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
$8.71 / $295.54 / $1,072.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $5.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.30 / $96.80 / $96.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,490.51 / $2,490.51 / $2,490.51
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $6.54 / $13.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.92 / $656.92 / $656.92