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Wisconsin rates for HCPCS G0257

Unscheduled Or Emergency Dialysis Treatment For An Esrd Patient In A Hospital Outpatient Department That Is Not Certified As As Esrd Facility

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $2,145.28 / $2,706.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.81 / $5.81 / $247.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.98 / $85.07 / $96.80
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
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $241.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $247.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.92 / $656.92 / $656.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $60.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.81 / $5.81 / $178.52
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $847.40 / $881.30
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.75 / $656.92 / $656.92