go back

Montana 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 / $993.59 / $1,988.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64,999.99 / $68,099.99 / $68,099.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.00 / $525.00 / $525.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.15 / $1,060.57 / $1,633.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00