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Pennsylvania 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
$1,047.13 / $7,244.36 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $323.59 / $1,348.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $446.68 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $398.11 / $537.03
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $436.52
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $371.54 / $562.34
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $5,370.32 / $13,803.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $363.08 / $1,071.52
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $660.69
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $331.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $309.03 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $363.08 / $562.34