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Montana rates for HCPCS 90997

Hemoperfusion (eg, with activated charcoal or resin)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.09 / $80.30 / $123.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.71 / $136.71 / $136.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.49 / $123.04 / $234.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.33 / $137.00 / $499.55
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.93 / $184.80 / $236.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.17 / $147.83 / $174.23