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New York 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
$993.59 / $993.59 / $3,528.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.98 / $1,060.57 / $1,060.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,746.00 / $6,410.00 / $13,166.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.59 / $60.69 / $82.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.00 / $360.00 / $1,574.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.42 / $269.42 / $325.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.66 / $426.66 / $426.66
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.00 / $360.00 / $1,574.00