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Idaho rates for HCPCS G0491

Dialysis procedure at a Medicare certified ESRD facility for acute kidney injury without ESRD

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.77 / $433.77 / $433.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.98 / $1,060.57 / $1,060.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.06 / $1,060.57 / $1,357.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $55.00 / $3,500.00