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Pennsylvania rates for HCPCS 33984

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), open, 6 years and older

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $5,526.00 / $13,947.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,480.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.00 / $5,526.00 / $13,969.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.33 / $273.33 / $322.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.00 / $2,391.00 / $6,322.00