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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
$691.83 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $478.63 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $630.96 / $776.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $2,344.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $954.99 / $1,023.29
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $977.24 / $1,348.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $537.03 / $891.25