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Virginia 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
$209.38 / $4,771.00 / $9,539.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.46 / $209.38 / $293.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.80 / $207.27 / $288.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.27 / $242.60 / $473.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.28 / $246.44 / $420.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.92 / $201.50 / $248.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.25 / $239.30 / $342.63
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$230.00 / $253.00 / $454.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.32 / $253.53 / $3,658.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.32 / $253.53 / $3,658.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,547.00 / $3,130.00 / $5,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.00 / $261.49 / $401.81