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Pennsylvania 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
$1,060.57 / $1,060.57 / $1,060.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.00 / $1,060.57 / $1,060.57
AmeriHealth
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.00 / $733.00 / $733.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $700.00 / $750.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.63 / $1,142.63 / $1,142.63
Independence Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$733.00 / $733.00 / $733.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.00 / $993.59 / $1,060.57
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.92 / $139.40 / $203.37
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $700.00 / $750.00