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New Hampshire 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
$100.00 / $100.00 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.73 / $567.95 / $567.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.23 / $864.13 / $1,379.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.36 / $1,086.78 / $1,341.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.29 / $964.67 / $1,663.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,448.00 / $7,448.00 / $7,448.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.16 / $936.85 / $1,825.73
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$362.10 / $398.31 / $506.94