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Maine rates for HCPCS 33957

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition peripheral (arterial and/or venous) cannula(e), percutaneous, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.00 / $275.77 / $275.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.96 / $233.17 / $350.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.19 / $275.77 / $385.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.96 / $222.59 / $346.35
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.00 / $275.77 / $275.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.27 / $266.38 / $346.15