HCPCS G0491

Dialysis procedure at a medicare certified esrd facility for acute kidney injury without esrd

Current codeHemodialysis12 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for HCPCS G0491 by hospital
HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$571 – $8475 plans——
Deaconess Medical CenterSpokaneFile dated 2026-08-27$523 – $5545 plans——
Island HospitalAnacortes$539 – $5853 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$541 – $5845 plans——
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$531 – $5735 plans——
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$531 – $5735 plans——
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$543 – $5875 plans——
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$519 – $5505 plans——
Olympic Medical CenterPort AngelesFile dated 2026-06-24$668 – $7325 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$543 – $5875 plans——
Virginia Mason Medical CenterSeattle———
Yakima Valley MemorialYakimaFile dated 2026-08-27$519 – $6035 plans——

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.