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Wisconsin rates for HCPCS 99475

Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,698.24 / $2,691.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $575.44 / $1,148.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $616.60 / $1,174.90
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,096.48 / $1,584.89
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $3,467.37