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Alaska rates for HCPCS 33957

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.17 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.38 / $1,022.18 / $1,022.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.07 / $629.07 / $629.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.58 / $1,022.18 / $1,461.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.68 / $1,134.00 / $1,462.96
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.00 / $783.00 / $1,199.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.58 / $1,022.18 / $1,461.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.89 / $804.00 / $1,282.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$503.26 / $754.89 / $1,164.08