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Utah rates for HCPCS 33964

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $549.54 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $891.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $2,570.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,122.02 / $1,174.90
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $1,122.02 / $1,548.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $776.25 / $2,398.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $630.96 / $1,023.29