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Tennessee 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
$1,592.54 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.53 / $983.05 / $1,741.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.00 / $2,324.00 / $4,232.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.13 / $1,075.25 / $1,931.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.82 / $1,258.48 / $1,788.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $14,418.24 / $14,786.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,672.08 / $5,814.08 / $6,873.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.00 / $2,665.00 / $4,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.12 / $1,287.65 / $2,015.04