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Arizona rates for HCPCS 33955

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,671.00 / $3,617.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.37 / $931.90 / $4,210.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.25 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.10 / $797.46 / $996.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.64 / $1,010.33 / $1,461.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$836.32 / $1,490.17 / $4,466.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.31 / $987.24 / $1,915.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.00 / $3,269.00 / $6,416.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.31 / $961.26 / $1,540.42