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Montana 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
Professional
Modifier
Low / Median / High Price
$472.24 / $2,154.40 / $2,154.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.26 / $647.26 / $647.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$566.42 / $647.26 / $647.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.26 / $647.26 / $647.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.46 / $568.75 / $868.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.12 / $738.60 / $1,142.38