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North Carolina 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
$1,071.52 / $1,071.52 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $1,071.52 / $1,905.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $112.20 / $112.20
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,071.52 / $1,698.24
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00