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Utah 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
$684.95 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.95 / $684.95 / $1,253.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.45 / $613.29 / $772.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.54 / $326.96 / $474.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.66 / $843.40 / $992.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.23 / $498.40 / $886.31