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Utah 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 / $1,383.39 / $1,470.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $631.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $133.19