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South Carolina rates for HCPCS 90997

Hemoperfusion (eg, with activated charcoal or resin)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $89.13 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $128.82 / $251.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $125.89 / $239.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $186.21
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $125.89 / $204.17
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $323.59 / $323.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $93.33 / $147.91