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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
$4,466.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $2,041.74 / $2,570.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $912.01 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $812.83 / $977.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $4,466.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $851.14 / $977.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $954.99 / $1,023.29
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $15,488.17 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,023.29