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South Dakota rates for HCPCS 99478

Subsequent Intensive Care Infant < 1500 Grams

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.82 / $122.43 / $435.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.08 / $231.80 / $289.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.67 / $197.12 / $269.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.90 / $236.30 / $1,352.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.20 / $251.86 / $264.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.20 / $222.00 / $281.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.45 / $228.23 / $291.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.90 / $228.35 / $265.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.30 / $271.20 / $271.20