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Missouri rates for HCPCS 33965

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $4,897.79 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $218.78 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,819.70 / $4,168.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $295.12 / $389.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $190.55 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $275.42 / $489.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $954.99 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $295.12 / $1,288.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $2,818.38 / $10,471.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $281.84 / $467.74