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Wisconsin 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
$1,071.52 / $1,071.52 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $1,071.52 / $1,737.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $64.57 / $81.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,071.52 / $1,071.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $147.91 / $229.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $1,479.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57