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Minnesota rates for HCPCS 99480

Subsequent Intensive Care Infant 2501-5000 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.88 / $106.88 / $106.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.59 / $119.19 / $453.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$195.99 / $206.31 / $657.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.74 / $295.54 / $359.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.38 / $400.14 / $962.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.15 / $314.06 / $454.66
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.38 / $329.31 / $757.94
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.08 / $304.54 / $390.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.88 / $180.63 / $313.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.99 / $241.29 / $779.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.79 / $234.20 / $385.68