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New York 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
$548.76 / $4,043.00 / $10,296.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.52 / $618.74 / $1,106.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.00 / $4,123.00 / $9,074.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.72 / $505.52 / $1,144.22
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.79 / $650.79 / $37,499.62
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.79 / $650.79 / $650.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.29 / $523.29 / $7,227.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.21 / $821.70 / $1,688.89
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $651.00 / $2,671.47
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$483.77 / $645.02 / $929.91
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$403.02 / $504.23 / $740.33
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$523.29 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.82 / $807.48 / $1,688.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,749.00 / $4,194.00 / $9,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.70 / $627.78 / $1,407.72
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$571.32 / $571.32 / $1,014.88
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.09 / $571.32 / $947.19