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Nebraska rates for HCPCS 33963

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)

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
$403.22 / $403.22 / $2,375.51
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
$386.29 / $658.44 / $877.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.95 / $1,000.37 / $1,356.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.11 / $857.12 / $10,954.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.25 / $1,020.15 / $1,336.39
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$804.99 / $992.72 / $1,356.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.46 / $1,000.37 / $1,356.00
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
$642.98 / $999.18 / $1,242.25