go back

Tennessee 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
$416.87 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $213.80 / $416.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,344.23 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $275.42 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $275.42 / $407.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $1,819.70 / $1,819.70
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,548.82 / $1,548.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $281.84 / $426.58