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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
$4,241.22 / $10,431.19 / $20,928.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.59 / $425.59 / $2,506.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,424.93 / $17,657.45 / $34,155.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.81 / $695.12 / $926.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.51 / $1,056.09 / $1,430.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.63 / $876.14 / $11,565.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.11 / $1,048.29 / $1,365.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$849.83 / $1,046.57 / $1,430.77
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.18 / $1,056.09 / $1,430.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,126.00 / $4,317.00 / $7,856.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.11 / $1,048.29 / $1,311.02