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Wisconsin rates for HCPCS 33957

Ecmo/Ecls Repos Periph Cannula Perq Birth-5 Yrs

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.81 / $350.19 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.41 / $216.81 / $350.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.00 / $3,496.00 / $5,962.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.19 / $422.95 / $1,050.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.24 / $508.61 / $820.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.72 / $526.60 / $699.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.20 / $242.47 / $337.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.17 / $2,803.00 / $7,868.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.15 / $600.84 / $969.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $256.57 / $504.12
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.20 / $242.47 / $337.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.00 / $542.00 / $708.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.92 / $1,852.92 / $1,852.92
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.29 / $860.80 / $1,295.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.39 / $894.39 / $894.39
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,180.08 / $1,180.08 / $1,180.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,203.00 / $4,316.80 / $19,003.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.15 / $610.53 / $846.56