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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
$462.15 / $462.15 / $462.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,046.00 / $1,179.00 / $1,415.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.17 / $725.53 / $1,116.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $3,239.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.49 / $1,215.10 / $1,932.48