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Texas 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
$1,000.00 / $3,715.35 / $12,882.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,230.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $741.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,148.15 / $1,905.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $56.23 / $14,454.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,623.41 / $6,918.31 / $6,918.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,621.81 / $6,918.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,023.29 / $1,949.84
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,122.02 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $2,454.71 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $1,479.11
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $812.83