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Montana 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
Professional
Modifier
Low / Median / High Price
$269.15 / $363.08 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $416.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $467.74 / $512.86
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $467.74 / $512.86
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $416.87 / $467.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $257.04 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $467.74 / $741.31