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Texas 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
$977.24 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $537.03 / $812.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $524.81 / $707.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $645.65 / $1,047.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $5,623.41
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,981.07 / $3,981.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,071.52 / $6,918.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $602.56 / $851.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $575.44 / $1,122.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $630.96 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $2,454.71 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $549.54 / $831.76
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $457.09