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Michigan 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
$645.65 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $575.44 / $741.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $707.95 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $707.95 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $741.31 / $794.33
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,513.56 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $588.84 / $758.58
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $691.83 / $912.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $3,890.45 / $6,025.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $724.44 / $954.99