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Vermont 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
$1,108.23 / $1,108.23 / $1,108.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.43 / $1,314.13 / $2,787.47
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,163.43 / $1,314.13 / $2,787.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.36 / $1,328.24 / $3,421.31