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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
$887.16 / $3,596.00 / $10,836.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$797.07 / $910.50 / $1,096.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.49 / $938.55 / $1,291.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$743.13 / $743.13 / $743.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.14 / $1,143.07 / $1,892.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $14,418.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,672.08 / $5,814.08 / $6,873.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.36 / $956.71 / $1,853.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.52 / $1,171.76 / $1,367.05
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.37 / $888.05 / $1,356.25
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$773.36 / $956.71 / $2,067.16
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.14 / $1,160.77 / $2,067.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $2,064.00 / $8,759.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.36 / $938.79 / $1,453.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.71 / $765.37 / $1,044.04