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Nebraska 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
$870.96 / $7,943.28 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $616.60 / $2,454.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,489.63 / $17,378.01 / $33,884.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $691.83 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,047.13 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $870.96 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,000.00 / $1,380.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,096.48 / $1,513.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $4,570.88 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,258.93