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Arizona 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
$1,671.00 / $3,617.00 / $6,329.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.09 / $525.99 / $2,375.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.25 / $6,640.00 / $10,860.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.81 / $450.41 / $563.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.57 / $569.25 / $823.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.33 / $864.37 / $4,466.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.81 / $556.33 / $1,079.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.00 / $3,269.00 / $6,416.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$447.81 / $527.04 / $878.41