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Tennessee rates for HCPCS 33953

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion 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
$1,071.52 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $549.54 / $1,122.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,344.23 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $707.95 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $707.95 / $1,047.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $5,623.41 / $5,623.41
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,981.07 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $724.44 / $1,096.48