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Virginia 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
$579.00 / $1,060.57 / $1,060.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.00 / $370.00 / $370.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.22 / $75.26 / $106.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.00 / $700.00 / $1,000.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.00 / $585.00 / $657.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.59 / $1,060.57 / $1,679.17
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,071.00 / $4,071.00 / $4,071.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,071.00 / $4,071.00 / $4,071.00