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Wisconsin rates for HCPCS 33953

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $891.25 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $549.54 / $1,122.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $851.14 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,288.25 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,380.38 / $1,548.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $7,413.10 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,148.15 / $1,348.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $3,388.44 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $954.99 / $2,511.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $1,862.09
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $2,187.76 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $3,019.95 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $933.25 / $1,995.26