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Utah 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
$446.68 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $302.00 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $407.38 / $501.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $1,202.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $630.96 / $660.69
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $616.60 / $870.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $426.58 / $501.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $354.81 / $575.44