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Wisconsin rates for MS-DRG 791

Prematurity With Major Problems

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,230.00 / $3,230.00 / $72,343.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.00 / $3,754.00 / $6,211.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,318.25 / $19,248.27 / $104,567.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,475.00 / $59,070.63 / $100,549.55
Network Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.00 / $1,942.07 / $2,228.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$650.79 / $40,944.08 / $58,684.88
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,589.96 / $3,284.29 / $67,912.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400.00 / $56,826.00 / $91,924.17