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Montana 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
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $631.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $68,099.99 / $68,099.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $694.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00