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Nebraska 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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.15 / $714.15 / $4,210.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,424.93 / $17,657.45 / $34,155.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.32 / $1,166.45 / $1,555.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.58 / $1,772.16 / $2,401.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$910.54 / $1,520.50 / $13,909.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.78 / $1,806.80 / $2,370.64
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.04 / $1,757.63 / $2,401.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.33 / $1,772.16 / $2,401.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,054.00 / $4,317.00 / $13,909.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$987.78 / $1,733.86 / $2,127.52