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New Hampshire rates for HCPCS 99480

Subsequent Intensive Care Infant 2501-5000 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$360.85 / $360.85 / $360.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.68 / $115.03 / $291.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.09 / $153.72 / $366.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.95 / $140.12 / $219.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.55 / $196.76 / $301.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.01 / $199.81 / $392.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.21 / $178.57 / $266.14
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.40 / $109.68 / $161.22