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Pennsylvania 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
$540.00 / $5,526.00 / $13,947.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.64 / $206.75 / $511.01
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.10 / $289.98 / $364.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.66 / $255.00 / $375.30
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.73 / $273.73 / $288.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $5,526.00 / $13,969.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.66 / $221.20 / $700.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.00 / $8.00 / $448.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.45 / $258.72 / $411.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.03 / $177.03 / $215.58
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.10 / $180.47 / $215.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.00 / $2,391.00 / $6,322.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.74 / $252.69 / $380.06