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Pennsylvania 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
$590.17 / $1,673.51 / $1,692.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $247.85
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.17 / $11.52 / $11.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.24 / $473.24 / $473.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $533.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.44 / $1,520.24 / $2,694.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $103.91
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.24 / $473.24 / $473.24
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $533.75