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Rhode Island 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
Facility
Modifier
Low / Median / High Price
$3,706.14 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.41 / $226.30 / $241.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.72 / $236.14 / $517.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.46 / $274.02 / $417.93
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
$193.44 / $252.01 / $407.38