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Arizona 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
$1,671.00 / $3,617.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.17 / $207.80 / $939.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.25 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.75 / $178.33 / $222.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.36 / $224.24 / $324.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.97 / $340.53 / $4,337.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.88 / $219.26 / $426.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.00 / $3,269.00 / $6,416.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.88 / $219.26 / $354.73