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Montana 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
Professional
Modifier
Low / Median / High Price
$467.74 / $602.56 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $724.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $812.83 / $870.96
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $812.83 / $870.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $724.44 / $812.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $446.68 / $891.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $812.83 / $1,288.25