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Texas 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
$5.81 / $658.15 / $2,050.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $103.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.03 / $1,760.08 / $3,116.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.30 / $9.76 / $9.76
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$862.67 / $862.67 / $862.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.24 / $473.24 / $898.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $533.75
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $881.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.92 / $656.92 / $656.92
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $16.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $16.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.07 / $85.07 / $119.10