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New Hampshire 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
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.25 / $1,007.67 / $1,007.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.98 / $1,531.13 / $2,442.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.41 / $1,925.35 / $2,377.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$894.63 / $1,707.97 / $2,945.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.35 / $1,368.81 / $3,143.68
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.07 / $706.28 / $898.90