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New Hampshire 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
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.43 / $216.16 / $216.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.96 / $340.81 / $546.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.05 / $428.97 / $529.62
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.04 / $381.90 / $658.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.97 / $324.29 / $721.46
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.16 / $167.22 / $252.55