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Washington 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
$5.80 / $498.12 / $1,337.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $390.25
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.97 / $1,195.97 / $1,195.97
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.96 / $96.80 / $1,085.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.28 / $171.28 / $171.28
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.91 / $1,715.58 / $2,784.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.00 / $1,691.00 / $79,999.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.97 / $1,195.97 / $1,980.32
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.07 / $85.07 / $85.07