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North Carolina rates for HCPCS 90997

Hemoperfusion (eg, with activated charcoal or resin)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.67 / $87.67 / $87.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.30 / $87.67 / $106.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.43 / $155.25 / $224.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.28 / $100.28 / $100.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.48 / $131.88 / $220.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.67 / $111.85 / $184.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.00 / $113.00 / $320.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.10 / $167.20 / $176.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.76 / $98.33 / $171.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.22 / $530.40 / $761.17
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.22 / $931.22 / $931.22