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Illinois 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
$537.03 / $3,090.30 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $338.84 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $3,162.28 / $6,165.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $398.11 / $467.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $416.87 / $588.84
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $457.09 / $1,659.59
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $346.74 / $389.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $2,884.03 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $426.58 / $645.65