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Pennsylvania rates for MS-DRG 791

Prematurity With Major Problems

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,668.00 / $62,086.50 / $89,679.50
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,008.00 / $8,192.64 / $67,476.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30,341.03 / $62,102.70 / $87,796.17
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
$20,463.74 / $47,106.79 / $91,165.48
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,825.00 / $62,029.60 / $89,139.70
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,175.01 / $53,664.04 / $85,563.72
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $31,056.40 / $45,125.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,000.00 / $45,541.98 / $86,826.07