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Utah rates for HCPCS 99478

Subsequent Intensive Care Infant < 1500 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.65 / $142.65 / $142.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.32 / $134.66 / $354.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.56 / $186.80 / $317.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.87 / $125.86 / $152.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.51 / $277.56 / $436.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.40 / $149.99 / $229.81