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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
$3,715.35 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,023.29 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $794.33 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,548.13 / $7,244.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,230.27 / $1,819.70