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Utah rates for HCPCS 99479

Subsequent Intensive Care Infant 1500-2500 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.93 / $130.93 / $130.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.41 / $130.93 / $329.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.76 / $168.00 / $288.56
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
$178.60 / $252.99 / $384.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.55 / $134.80 / $204.17