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New Hampshire rates for HCPCS 99479

Subsequent Intensive Care Infant 1500-2500 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$375.04 / $375.04 / $375.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.70 / $119.58 / $313.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.96 / $132.96 / $159.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.15 / $146.19 / $228.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.40 / $204.63 / $313.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $207.40 / $406.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.38 / $188.14 / $290.02
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.16 / $114.19 / $167.86