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South Dakota rates for HCPCS 33965

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $204.17 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $288.40 / $524.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $316.23 / $1,288.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $416.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $331.13 / $346.74
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
$223.87 / $354.81 / $489.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $426.58 / $436.52