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Michigan 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
$1,096.48 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $977.24 / $1,412.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,258.93 / $1,380.38
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,630.27 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,737.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,202.26 / $1,584.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,230.27 / $1,621.81