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Ohio 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
$538.36 / $4,723.00 / $11,627.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$538.36 / $546.03 / $1,666.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,145.00 / $2,786.00 / $8,800.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.57 / $588.63 / $972.97
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$468.82 / $468.82 / $682.65
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.58 / $505.58 / $651.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.62 / $692.92 / $1,059.19
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.83 / $705.51 / $1,049.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.58 / $586.66 / $780.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.00 / $3,098.00 / $6,792.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.57 / $671.84 / $1,039.50