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Wyoming 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
$457.09 / $467.74 / $1,096.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,174.90 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $724.44 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,905.46