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Rhode Island 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
$3,706.14 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.25 / $1,016.52 / $1,086.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.30 / $1,055.65 / $1,685.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$840.20 / $1,222.85 / $1,873.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,649.00 / $4,915.00 / $7,205.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.65 / $1,185.77 / $1,826.14