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Indiana 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
$492.47 / $563.41 / $4,846.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.52 / $517.26 / $667.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.00 / $5,790.87 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.77 / $692.65 / $935.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.39 / $520.49 / $600.57
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$420.40 / $480.46 / $600.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.86 / $681.56 / $1,668.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.00 / $5,242.00 / $10,843.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.32 / $644.95 / $968.00