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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
$1,007.67 / $1,237.25 / $1,237.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.98 / $1,042.79 / $1,576.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,040.36 / $1,237.25 / $1,725.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.27 / $995.46 / $1,548.94
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$841.85 / $1,007.67 / $1,237.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.27 / $1,221.83 / $1,548.94