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New Hampshire 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
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.02 / $499.35 / $499.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.04 / $782.74 / $1,253.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.10 / $984.58 / $1,215.59
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.98 / $876.26 / $1,511.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.45 / $744.48 / $1,612.64
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.48 / $361.33 / $459.87