go back

Texas 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
$993.59 / $1,060.57 / $1,060.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.42 / $79.80 / $200.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.00 / $650.00 / $750.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.59 / $1,060.57 / $2,248.41
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.98 / $131.75 / $182.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.59 / $1,060.57 / $2,248.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.26 / $78.26 / $109.56