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South Dakota rates for HCPCS 33955

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.71 / $825.71 / $825.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.72 / $825.71 / $825.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.20 / $1,691.43 / $2,114.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.84 / $1,287.31 / $2,338.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.42 / $1,655.70 / $5,814.08
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,695.22 / $1,929.13 / $2,528.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.48 / $1,863.97 / $2,401.61
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,049.17 / $1,370.27 / $1,562.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.74 / $1,603.12 / $2,201.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.40 / $1,895.80 / $1,971.60