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Alaska rates for MS-DRG 173

Ultrasound accelerated & oth thrombolysis w PDX pulmonary embolism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40,952.90 / $78,347.80 / $159,182.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119,758.43 / $119,758.43 / $127,241.10
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $46,283.02 / $75,273.99
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,500.00 / $47,713.62 / $127,241.10