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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
$489.78 / $794.33 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $758.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $831.76 / $912.01
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $831.76 / $912.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $758.58 / $831.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $467.74 / $933.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $851.14 / $1,318.26