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Pennsylvania 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
$1,047.13 / $7,244.36 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $218.78 / $616.60
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $302.00 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $269.15 / $363.08
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $269.15 / $295.12
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $257.04 / $380.19
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $5,370.32 / $13,803.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $245.47 / $616.60
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $446.68
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $223.87 / $223.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $223.87 / $588.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $245.47 / $380.19