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Tennessee rates for HCPCS 33965

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.18 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.26 / $215.24 / $293.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.00 / $2,326.00 / $4,936.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.08 / $239.14 / $429.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.22 / $279.94 / $397.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,216.50 / $2,264.67
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,267.59 / $1,295.83 / $1,537.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,233.00 / $2,665.00 / $4,918.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.88 / $287.45 / $446.85