go back

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
$303.07 / $1,385.59 / $1,385.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.96 / $416.96 / $416.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$374.08 / $416.96 / $416.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.96 / $416.96 / $416.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.83 / $374.08 / $557.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.32 / $474.60 / $734.44