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Oklahoma 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
$1,022.17 / $3,684.00 / $18,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.17 / $1,022.17 / $1,053.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$928.39 / $1,110.16 / $1,218.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$862.14 / $1,236.06 / $1,402.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $1,300.96 / $6,272.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$738.38 / $1,067.70 / $5,814.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $1,760.00 / $6,155.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$714.75 / $1,033.74 / $1,419.62