go back

Maine rates for HCPCS 33958

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, 6 years and older (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.99 / $254.62 / $275.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.96 / $233.17 / $350.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.19 / $275.77 / $385.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.96 / $222.59 / $346.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.66 / $216.16 / $275.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.14 / $264.33 / $346.15