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Washington 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
$891.25 / $1,737.80 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $602.56 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $954.99 / $1,412.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,023.29 / $1,318.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,023.29 / $1,318.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $912.01 / $954.99
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $1,071.52 / $1,412.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $933.25 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $3,311.31 / $37,153.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $776.25 / $1,348.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $602.56 / $831.76