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Louisiana 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
$550.00 / $2,562.00 / $4,050.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.00 / $656.10 / $715.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,068.86 / $2,395.33 / $3,212.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$639.73 / $838.26 / $1,089.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.95 / $691.19 / $960.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.00 / $1,309.00 / $7,168.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.25 / $731.12 / $1,076.08