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Maryland 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
Professional
Modifier
Low / Median / High Price
$525.20 / $566.66 / $632.37
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.13 / $613.09 / $778.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$434.73 / $587.42 / $1,173.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.13 / $611.63 / $1,010.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.00 / $572.71 / $956.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.13 / $474.13 / $666.36