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Massachusetts rates for HCPCS 33955

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; insertion of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $3,388.44 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $3,630.78
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,454.71 / $7,244.36
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,258.93 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $2,884.03
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,230.27 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,047.13 / $1,905.46
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $3,311.31 / $5,888.44
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $2,089.30
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $2,454.71 / $7,244.36
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,258.93 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,884.03 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,445.44 / $2,511.89