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New Hampshire rates for MS-DRG 791

Prematurity With Major Problems

Insurance Carrier
Ambetter
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,724.13 / $23,724.13 / $42,552.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,692.00 / $32,780.00 / $75,453.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.00 / $5,166.00 / $83,767.69
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38,428.85 / $58,680.96 / $86,209.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.93 / $6,199.00 / $83,168.91