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New Mexico 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
$2,034.43 / $2,528.94 / $4,000.86
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $60.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $473.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.75 / $2,250,000.00 / $2,400,000.00