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Montana rates for HCPCS 99479

Subsequent Intensive Care Infant 1500-2500 Grams

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.67 / $122.62 / $334.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,099.99 / $68,099.99 / $81,499.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.89 / $188.76 / $188.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.76 / $188.76 / $188.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.96 / $169.88 / $267.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.94 / $138.05 / $233.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.53 / $204.28 / $324.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.45 / $197.13 / $225.29