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Washington rates for MS-DRG 790

Extreme immaturity or respiratory distress syndrome, neonate

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92,302.60 / $147,221.00 / $259,255.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,998.00 / $94,967.88 / $162,632.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,757.00 / $107,391.62 / $178,457.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,200.00 / $80,571.67 / $99,261.75
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29,312.06 / $90,839.60 / $148,226.69
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,700.00 / $102,439.71 / $155,192.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39,316.25 / $128,896.68 / $182,162.33