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Montana 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
Professional
Modifier
Low / Median / High Price
$549.46 / $2,506.92 / $2,506.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.52 / $754.52 / $754.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.52 / $754.52 / $754.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.42 / $754.52 / $754.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.52 / $754.52 / $754.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.13 / $661.79 / $1,010.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.79 / $595.79 / $595.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.64 / $859.20 / $1,328.30