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South Dakota rates for HCPCS 33963

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.36 / $466.36 / $466.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.07 / $466.36 / $466.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$900.83 / $955.18 / $1,193.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$449.49 / $726.82 / $1,318.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.80 / $934.68 / $3,281.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$955.50 / $1,088.83 / $1,427.64
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.54 / $1,051.49 / $1,356.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$591.61 / $773.93 / $882.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.52 / $1,189.01 / $1,242.25
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$910.10 / $1,070.70 / $1,113.59