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Wisconsin 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
$213.80 / $346.74 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $213.80 / $346.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $331.13 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $512.86 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $537.03 / $616.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $7,413.10 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $446.68 / $524.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $3,388.44 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $371.54 / $977.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $436.52 / $724.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $1,819.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $851.14 / $1,258.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $1,202.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $6,165.95 / $19,498.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $363.08 / $794.33