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Wisconsin rates for HCPCS 33964

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $933.25 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $575.44 / $1,047.13
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
$457.09 / $891.25 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $1,348.96 / $2,187.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,445.44 / $1,621.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $7,413.10 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,202.26 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $3,388.44 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $2,570.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,148.15 / $1,949.84
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $2,290.87 / $3,388.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $2,398.83
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.53 / $3,162.28 / $3,630.78
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
$562.34 / $977.24 / $2,089.30