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Maine 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
$917.98 / $993.59 / $1,060.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$561.60 / $561.60 / $561.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.03 / $77.29 / $107.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.00 / $917.98 / $1,060.57