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New Mexico 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
$509.66 / $7,838.38 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.09 / $485.56 / $848.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.00 / $742.50 / $935.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $725.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.25 / $684.90 / $935.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,085.00 / $4,262.00 / $17,636.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.72 / $787.07 / $1,010.15