go back

Tennessee rates for HCPCS 33969

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $2,691.53 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $323.59 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,344.23 / $4,897.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $407.38 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $416.87 / $602.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $3,235.94 / $3,235.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,238.72 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,630.27 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $426.58 / $630.96