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Wisconsin rates for MS-DRG 792

Prematurity Without Major Problems

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,228.00 / $2,228.00 / $43,652.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,452.00 / $2,110.00 / $4,161.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,375.25 / $11,614.40 / $63,096.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,822.00 / $35,643.21 / $60,671.58
Network Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,375.00 / $1,639.00 / $1,804.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.69 / $24,705.22 / $35,409.83
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.06 / $1,717.49 / $40,978.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,794.00 / $34,288.80 / $55,467.03