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Rhode Island 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
$3,706.14 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.73 / $573.67 / $612.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$506.83 / $596.27 / $1,030.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.21 / $690.98 / $1,058.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,649.00 / $4,915.00 / $7,205.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.05 / $668.57 / $1,374.43