go back

Idaho rates for HCPCS 33953

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $602.56 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,778.28 / $2,511.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $794.33 / $933.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $954.99 / $4,466.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $831.76 / $954.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $912.01 / $977.24
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $870.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $15,488.17 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,000.00