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South Dakota 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 / $1,060.57 / $1,060.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.00 / $525.00 / $525.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.77 / $867.54 / $2,121.14