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Utah rates for HCPCS 33987

Arterial exposure with creation of graft conduit (eg, chimney graft) to facilitate arterial perfusion for ECMO/ECLS (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $3,388.44 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $234.42 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $302.00 / $380.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $60.26 / $891.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $457.09 / $478.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $478.63 / $660.69
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $323.59 / $389.05
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
$199.53 / $269.15 / $436.52