go back

Wisconsin rates for HCPCS 33987

Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $389.05 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $245.47 / $457.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,964.78 / $17,378.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $371.54 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $575.44 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $602.56 / $691.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $7,413.10 / $14,454.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $501.19 / $588.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $3,388.44 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $407.38 / $1,096.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $489.78 / $691.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $1,258.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $977.24 / $1,412.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $1,348.96
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
$234.42 / $398.11 / $891.25