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Vermont 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
Professional
Modifier
Low / Median / High Price
$624.66 / $624.66 / $624.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.46 / $742.25 / $1,574.03
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.46 / $742.25 / $1,574.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$609.96 / $715.22 / $1,931.94