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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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.94 / $1,065.13 / $2,448.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,125.10 / $1,377.28 / $1,537.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.55 / $1,307.97 / $3,134.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.93 / $1,367.05 / $1,562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,232.25 / $1,373.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.11 / $1,604.93 / $1,633.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $15,298.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.54 / $1,275.72 / $1,781.19