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Montana 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
$520.98 / $2,375.51 / $2,375.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.56 / $714.56 / $714.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$643.22 / $714.56 / $714.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.56 / $714.56 / $714.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$442.87 / $643.22 / $958.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.65 / $814.21 / $1,258.01