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Maine rates for MS-DRG 790

Extreme immaturity or respiratory distress syndrome, neonate

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.01 / $90,389.07 / $131,558.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72,510.70 / $91,791.41 / $91,791.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $76,849.00