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New Hampshire 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
$100.00 / $2,398.83 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $316.23 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $575.44 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $660.69 / $776.25
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $512.86 / $776.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,413.10 / $7,413.10 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $512.86 / $977.24