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Maine rates for HCPCS 33964

Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; reposition central cannula(e) by sternotomy or thoracotomy, 6 years and older (includes fluoroscopic guidance, when performed)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $575.44 / $831.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $676.08 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $676.08 / $1,023.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $676.08 / $870.96
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $660.69 / $831.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $707.95 / $912.01