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Tennessee 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
$898.58 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.18 / $548.78 / $898.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.00 / $2,302.00 / $4,528.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.20 / $603.04 / $983.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$479.16 / $710.94 / $1,078.21
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $10,688.16 / $10,954.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,203.04 / $3,281.60 / $3,882.68
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
$451.35 / $726.16 / $1,174.36