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Pennsylvania 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
$1,023.29 / $7,244.36 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $2,089.30
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $776.25 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $676.08 / $933.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $758.58
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $645.65 / $954.99
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $5,370.32 / $13,803.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $602.56 / $1,584.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $1,148.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $457.09 / $562.34
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $467.74 / $562.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $616.60 / $977.24