go back

Indiana rates for HCPCS 33951

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.93 / $497.35 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.46 / $469.35 / $605.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.00 / $5,790.87 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.92 / $609.91 / $823.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$370.63 / $472.37 / $545.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.53 / $436.03 / $545.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.95 / $600.13 / $905.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.35 / $534.11 / $857.32