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Missouri 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
$289.63 / $4,470.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.48 / $276.70 / $289.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.16 / $339.31 / $470.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.90 / $352.89 / $664.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $468.82 / $6,335.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.05 / $403.97 / $1,647.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,185.00 / $3,233.00 / $11,343.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.05 / $370.36 / $686.10