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North Carolina 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
$219.11 / $722.07 / $1,046.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $390.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.76 / $1,085.96 / $1,085.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.24 / $473.24 / $473.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.75 / $533.75 / $533.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $8.53
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.80 / $656.92 / $656.92