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Utah rates for HCPCS 33985

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $575.44 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $758.58 / $933.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $2,691.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,174.90 / $1,258.93
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $1,174.90 / $1,621.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $812.83 / $2,570.40
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
$501.19 / $660.69 / $1,071.52