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Nebraska rates for HCPCS 33951

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.75 / $365.75 / $2,154.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,424.93 / $17,657.45 / $34,155.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.18 / $596.89 / $795.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$536.59 / $906.85 / $1,229.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.33 / $753.60 / $5,198.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.22 / $901.66 / $1,174.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.73 / $901.73 / $1,229.33
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.22 / $906.85 / $1,229.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,054.00 / $4,317.00 / $13,909.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.95 / $905.90 / $1,088.16