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New Hampshire 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
$832.00 / $993.59 / $1,060.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.03 / $77.29 / $78.26
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $3,000.00 / $4,410.00