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Pennsylvania rates for MS-DRG 790

Extreme immaturity or respiratory distress syndrome, neonate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,668.00 / $91,916.20 / $132,695.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,008.00 / $8,192.64 / $98,800.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44,427.66 / $80,356.12 / $125,477.00
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
$44,400.74 / $133,515.32 / $219,766.04
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,715.00 / $90,911.80 / $130,525.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,791.73 / $77,847.96 / $125,288.98
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $45,255.42 / $66,075.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,640.00 / $71,322.00 / $124,480.66