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Illinois 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
$1,023.29 / $3,090.30 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $9,549.93 / $18,620.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,202.26 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,258.93 / $1,819.70
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,412.54 / $4,570.88
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,174.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $2,884.03 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,318.26 / $1,949.84