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Utah rates for HCPCS 99480

Subsequent Intensive Care Infant 2501-5000 Grams

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.26 / $122.26 / $122.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.16 / $122.26 / $402.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.73 / $161.13 / $277.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.61 / $93.51 / $114.31
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.64 / $242.19 / $369.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.15 / $131.43 / $194.41