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Idaho rates for HCPCS 33969

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $812.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,148.15 / $1,412.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $501.19 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $457.09 / $537.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $549.54 / $4,466.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $478.63 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $524.81 / $562.34
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $15,488.17 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $398.11 / $575.44