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Wisconsin rates for HCPCS 33987

Artery Expos/Graft Artery Perfusion Ecmo/Ecls

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.88 / $393.26 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.08 / $243.88 / $393.26
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,720.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.17 / $478.19 / $1,186.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.31 / $571.79 / $922.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.48 / $593.26 / $784.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.26 / $273.24 / $379.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.36 / $2,803.00 / $7,868.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.70 / $664.07 / $1,094.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $256.57 / $504.12
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.26 / $273.24 / $379.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.90 / $608.24 / $797.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$917.37 / $917.37 / $917.37
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.56 / $969.65 / $1,462.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,009.41 / $1,009.41 / $1,009.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.75 / $1,329.45 / $1,329.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,203.00 / $4,316.80 / $19,003.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.72 / $677.55 / $1,094.34