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Pennsylvania rates for MS-DRG 789

Neonates, died or transferred to another acute care facility

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,715.00 / $27,871.00 / $40,235.90
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,856.85 / $46,856.85 / $46,856.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,008.00 / $8,459.92 / $38,899.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,471.45 / $27,573.66 / $43,622.25
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,708.00 / $4,708.00 / $4,708.00
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,575.01 / $15,615.69 / $40,858.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,895.00 / $27,566.50 / $39,578.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,065.73 / $23,826.89 / $37,998.81
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $14,069.51 / $20,036.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,850.00 / $20,220.68 / $39,547.48