| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $805.53 | $805.53 | $805.53 | |
Providence
| Facility | $805.53 | $805.53 | $805.53 |
Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support (ECLS) provided by physician; removal of central cannula(e) by sternotomy or thoracotomy, 6 years and older
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $805.53 | $805.53 | $805.53 | |
Providence
| Facility | $805.53 | $805.53 | $805.53 |