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Idaho 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
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.28 / $301.64 / $691.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.13 / $389.44 / $434.78
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.56 / $370.73 / $885.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.59 / $365.59 / $443.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $349.30 / $389.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.72 / $455.22 / $461.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $15,298.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.09 / $350.42 / $502.46