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Pennsylvania rates for MS-DRG 004

Peripheral, Cranial Nerve and Other Nervous System Procedures with MCC

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124,912.00 / $226,457.00 / $309,246.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,651.89 / $186,091.27 / $303,216.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103,539.22 / $191,149.32 / $297,860.40
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$228,243.37 / $228,243.37 / $277,152.65
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175,333.57 / $284,502.15 / $622,480.52
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124,690.00 / $217,509.00 / $306,033.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105,800.32 / $185,137.81 / $288,787.84
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,621.40 / $107,149.84 / $157,037.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,269.00 / $174,804.67 / $290,602.37