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South Dakota rates for HCPCS 33959

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $234.42 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $257.04 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $616.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $363.08 / $660.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $398.11 / $1,659.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $524.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $416.87 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $457.09 / $616.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $537.03 / $562.34