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Delaware 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
$6,907.00 / $6,907.00 / $6,907.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.84 / $509.84 / $552.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.34 / $645.41 / $733.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.02 / $593.23 / $1,205.54