go back

Idaho rates for HCPCS 33964

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.46 / $634.07 / $1,458.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$669.59 / $819.67 / $915.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.33 / $778.64 / $1,866.70
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.48 / $814.00 / $930.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $733.93 / $817.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.80 / $956.43 / $973.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,700.00 / $15,298.00 / $26,104.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.10 / $734.50 / $1,059.67