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Arizona rates for HCPCS 33959

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 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
$243.28 / $260.48 / $1,188.97
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
$169.66 / $226.21 / $282.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.28 / $284.91 / $412.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.18 / $432.65 / $4,337.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.07 / $278.54 / $540.23
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
$224.07 / $263.88 / $434.82