go back

Indiana rates for HCPCS G0491

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.77 / $1,060.57 / $1,060.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.00 / $370.00 / $553.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $45.00 / $67.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.97 / $501.97 / $501.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$480.00 / $700.00 / $700.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $1.81 / $1.81