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Georgia 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
$525.20 / $5,063.00 / $7,421.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.09 / $525.20 / $1,022.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$996.37 / $2,722.51 / $5,292.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.90 / $721.87 / $1,160.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.42 / $798.47 / $1,303.51
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.39 / $629.29 / $4,561.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$739.45 / $772.81 / $831.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,036.00 / $3,629.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.26 / $758.35 / $1,238.29