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Montana 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
Professional
Modifier
Low / Median / High Price
$205.83 / $939.38 / $939.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.83 / $281.83 / $281.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.50 / $281.83 / $281.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.83 / $281.83 / $281.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.01 / $253.50 / $378.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.72 / $321.60 / $496.71