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Pennsylvania 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
$1,047.13 / $7,244.36 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $549.54 / $1,412.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20,417.38 / $21,379.62 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $776.25 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $691.83 / $933.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $758.58
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $645.65 / $977.24
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $5,370.32 / $13,803.84
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $616.60 / $1,445.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $1,122.02
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $446.68 / $562.34
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $457.09 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $2,570.40 / $6,760.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $616.60 / $954.99