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Virginia 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
$244.60 / $494.01 / $508.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $178.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.52 / $85.07 / $116.67
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 / $533.75 / $533.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $9.82
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.88 / $91.88 / $91.88
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,071.00 / $4,071.00 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,071.00 / $4,071.00 / $4,071.00