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Kentucky 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
$796.78 / $1,093.63 / $8,229.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.78 / $912.58 / $1,182.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,014.00 / $8,584.00 / $11,253.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.40 / $760.48 / $956.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.11 / $1,054.19 / $1,216.08
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.05 / $1,054.19 / $1,505.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$927.49 / $927.49 / $927.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$849.32 / $1,192.01 / $2,248.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.00 / $4,298.00 / $30,001.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.33 / $1,348.95 / $1,732.39