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Maine 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
Professional
Modifier
Low / Median / High Price
$575.44 / $1,000.00 / $1,412.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,148.15 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,174.90 / $1,737.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,122.02 / $1,479.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,096.48 / $2,089.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,202.26 / $1,548.82