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Michigan 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
$363.08 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $323.59 / $489.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $398.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $398.11 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $416.87 / $446.68
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $851.14 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $331.13 / $457.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $389.05 / $512.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $537.03