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Alaska rates for HCPCS 33963

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition of central cannula(e) by sternotomy or thoracotomy, birth through 5 years of age (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.49 / $10,900.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,375.51 / $2,593.88 / $2,593.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.71 / $1,595.71 / $1,595.71
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.34 / $2,593.88 / $3,709.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.03 / $2,864.40 / $3,712.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,705.00 / $1,977.80 / $3,050.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.34 / $2,593.88 / $3,709.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.86 / $2,035.50 / $3,253.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.56 / $1,914.84 / $2,957.16