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Idaho 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
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,071.52 / $2,454.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $3,388.44 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,380.38 / $1,621.81
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,659.59 / $4,466.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,445.44 / $1,659.59
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
$1,513.56 / $1,621.81 / $1,698.24
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $1,513.56
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
$912.01 / $1,230.27 / $1,778.28