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Maine 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
$567.95 / $697.81 / $697.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.23 / $588.97 / $888.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$587.42 / $697.81 / $974.49
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.09 / $562.24 / $874.85
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.95 / $697.81 / $697.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.24 / $699.81 / $874.85