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South Dakota rates for HCPCS 99479

Subsequent Intensive Care Infant 1500-2500 Grams

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.36 / $117.78 / $333.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.39 / $211.11 / $263.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.04 / $179.14 / $244.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.53 / $210.85 / $1,082.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$172.73 / $229.03 / $240.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.73 / $205.00 / $255.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.63 / $201.99 / $264.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.53 / $173.82 / $240.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.10 / $246.30 / $246.30