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Utah 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
$1,375.85 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.75 / $1,375.85 / $2,448.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.31 / $1,223.39 / $1,510.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.36 / $680.10 / $985.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.83 / $1,694.09 / $1,993.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.31 / $975.21 / $1,733.05