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Iowa rates for HCPCS 33955

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion 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
$1,230.27 / $5,370.32 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,023.29 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,905.46 / $2,187.76
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,230.27 / $2,951.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $2,187.76 / $7,244.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,698.24 / $3,162.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,949.84 / $3,388.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,187.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,445.44 / $1,905.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,248.07 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,380.38 / $2,570.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $1,905.46