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Maine rates for HCPCS 90997

Hemoperfusion (eg, with activated charcoal or resin)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.81 / $93.82 / $110.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.16 / $111.95 / $171.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.28 / $100.28 / $100.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.58 / $113.68 / $195.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.02 / $142.84 / $249.10
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.81 / $93.82 / $110.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.06 / $127.53 / $178.48