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North Carolina 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
$454.11 / $732.72 / $7,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.11 / $454.11 / $732.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$753.10 / $1,005.93 / $1,616.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.94 / $823.32 / $1,346.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$428.08 / $695.80 / $919.45
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.80 / $695.80 / $695.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.13 / $543.16 / $702.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.00 / $4,086.00 / $7,778.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.60 / $732.41 / $1,304.21
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,872.92 / $10,688.16
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,203.04 / $3,882.68 / $3,882.68