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New Hampshire 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
$5.80 / $5.80 / $2,952.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $247.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.30 / $85.65 / $85.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,247.68 / $2,306.71 / $2,943.34
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,750.00 / $3,440.00 / $7,965.00