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Montana 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
Professional
Modifier
Low / Median / High Price
$831.76 / $1,071.52 / $2,454.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,258.93
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,412.54 / $1,548.82
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,412.54 / $1,548.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $1,258.93 / $1,412.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $776.25 / $1,548.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,412.54 / $2,238.72