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Utah rates for HCPCS 33962

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), open, 6 years and older (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.01 / $3,038.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.01 / $366.01 / $691.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.20 / $339.34 / $428.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.77 / $167.16 / $237.05
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.20 / $450.67 / $530.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,312.00 / $2,446.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.07 / $275.20 / $488.88