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Illinois 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
$573.67 / $1,624.08 / $5,549.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.93 / $573.67 / $915.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,539.04 / $5,431.12 / $10,875.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$568.91 / $680.84 / $795.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$509.77 / $730.23 / $1,142.90
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.30 / $784.89 / $2,386.31
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.95 / $597.03 / $666.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $754.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.00 / $2,873.00 / $7,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.74 / $742.11 / $1,178.31