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Michigan 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
$630.96 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $851.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $660.69 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $707.95 / $758.58
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,445.44 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $758.58
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $660.69 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $912.01